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ACKNOWLEDGEMENT OF RISK AND HOLD HARMLESS AGREEMENT

I HEREBY ACKNOWLEDGE THAT I HAVE VOLUNTARILY CHOSEN TO USE THE FACILITIES AND PARTICIPATE IN THE
ACTIVITIES AT ROCK CREEK YOUTH CAMP, 4606 EAST ROCK CREEK ROAD NORMAN, OK 73071. THIS INCLUDES, BUT IS
NOT LIMITED TO THE CHAPEL, THE FIELDS, THE TRAILS, THE POND, THE KITCHEN AND DINING AREA, CABINS AND
BATH HOUSES (HEREINAFTER CALLED “THE CAMP”).

I UNDERSTAND THE RISKS INVOLVED IN THE CAMP. I RECOGNIZE THAT THE PROGRAMS AND ITS ACTIVITIES INVOLVE
RISK OF INJURY AND I AGREE TO ACCEPT ANY AND ALL RISKS ASSOCIATED WITH IT, INCLUDING BUT NOT LIMITED TO
3rd - 8th Grade Camp Session
PROPERTY DAMAGE OR LOSS, MINOR BODILY INJURY, SEVERE BODILY INJURY AND DEATH. FURTHERMORE, I
RECOGNIZE THAT PARTICIPATION AT THE CAMP INVOLVES ACTIVITIES AND RISKS INCIDENTAL THERETO, INCLUDING
BUT NOT LIMITED TO, TRAVEL TO AND FROM, LIMITED AVAILABILITY OF MEDICAL ASSISTANCE AND THE POSSIBLE
June 6th-11th
RECKLESS CONDUCT OF OTHER PARTICIPANTS. I AM VOLUNTARILY PARTICIPATING IN THE VISIT TO THE CAMP WITH
THE KNOWLEDGE OF RISKS INVOLVED AND HEREBY AGREE TO ACCEPT ANY AND ALL INHERENT RISKS OF PROPERTY
DAMAGE, BODILY INJURY OR DEATH.

IN CONSIDERATION OF MY PARTICIPATION IN THE VISIT TO THE CAMP AND TO THE FULLEST EXTENT PERMITTED BY
LAW, I AGREE TO INDEMNIFY, DEFEND AND HOLD HARMLESS ROCK CREEK YOUTH CAMP, ITS BOARD MEMBERS,
VOLUNTEERS AND STAFF MEMBERS FROM AND AGAINST ANY AND ALL CLAIMS ARISING OUT OF OR RESULTING FROM
MY PARTICIPATION IN THE VISIT. “CLAIM” AS USED IN THIS AGREEMENT MEANS ANY FINANCIAL LOSS, CLAIM, SUIT,
ACTION, DAMAGE OR EXPENSE, INCLUDING BUT NOT LIMITED TO ATTORNEY’S FEES, ATTRIBUTABLE TO BODILY
INJURY, SICKNESS, DISEASE OR DEATH, OR INJURY OR DESTRUCTION OF TANGIBLE PROPERTY INCLUDING LOSS OF
USE RESULTING THERE FROM. IN ADDITION, I HEREBY VOLUNTARILY HOLD HARMLESS ROCK CREEK YOUTH CAMP, ITS
BOARD MEMBERS, VOLUNTEERS AND STAFF MEMBERS FROM AND AGAINST ANY AND ALL CLAIMS, BOTH PRESENT
AND FUTURE, THAT MAY BE MADE BY ME, MY FAMILY, ESTATE, HEIRS OR ASSIGNS.

I HEREBY EXPRESSLY AGREE TO INDEMNIFY, DEFEND AND HOLD HARMLESS ROCK CREEK YOUTH CAMP, ITS BOARD
MEMBERS, VOLUNTEERS AND STAFF MEMBERS FOR ANY CLAIM ARISING OUT OF OR INCIDENT TO MY PARTICIPATION
IN THE CAMP, UNLESS CLAIM IS CAUSED BY THE SOLE NEGLIGENCE OR WILLFUL MISCONDUCT OF ROCK CREEK
YOUTH CAMP, ITS BOARD MEMBERS, VOLUNTEERS AND STAFF MEMBERS.

I ALSO UNDERSTAND THAT ROCK CREEK YOUTH CAMP, ITS BOARD MEMBERS, VOLUNTEERS AND STAFF MEMBERS
DOES NOT PROVIDE ANY MEDICAL OR DENTAL INSURANCE OR LIFE INSURANCE TO COVER BODILY INJURY, ILLNESS
OR DEATH, NOR INSURANCE FOR PERSONAL PROPERTY DAMAGE OR LOSS, NOR INSURANCE FOR LIABILITY ARISING
OUT OF MY NEGLIGENT ACTS OR OMISSIONS; AND I ACKNOWLEDGE THAT I AM COMPLETELY RESPONSIBLE FOR MY
OWN INSURANCE TO COVER THESE EXPENSES.

I FURTHER UNDERSTAND THAT THIS ACKNOWLEDGEMENT OF RISK AND HOLD HARMLESS IS INTENDED TO BE AS
BROAD AND INCLUSIVE AS PERMITTED BY THE LAWS OF THE STATE OF OKLAHOMA AND THAT IF ANY PORTION
HEREOF IS HELD INVALID, I AGREE THAT THE BALANCE SHALL, NOTWITHSTANDING, CONTINUE IN FULL LEGAL FORCE
AND EFFECT.

Join us in Norman, Oklahoma for “God’s Greatest Hits”, which started in Genesis and ends
I AGREE THAT THIS ACKNOWLEDGEMENT OF RISK AND HOLD HARMLESS IS EFFECTIVE FOR AS LONG AS I with you! Camp Rock Creek is for campers going into the 3rd grade through those
PARTICIPATE IN THE VISIT TO THE CAMP.
entering the 8th grade. In an effort to bring campers closer to God, Camp Rock Creek
strives to provide a rich learning environment Bible lessons, worship/devotions and
PARENT OR LEGAL GUARDIAN SIGNATURE: _________________________________________ Date: _________________ activities. We also provide lots of interaction with caring adults and older teens through
crafts, sport activities and swimming. Camp Rock Creek is a great way for campers to
PRINTED NAME: ______________________________________ become closer to Christ and build faith for the future.

Early-Bird Applications are due Monday, May 17th


Camper Registration Form 2010
Fill out both sides of this form and turn it in with your payment by May 17th.
This session of camp is for those who will be entering 3rd grade through One application per person.
those entering 8th grade in the fall of 2010. Name:_____________________________________________ Grade (Fall 2010)______________
Schedule:
Check-in begins at 5:00pm, Sunday, June 6th. Campers and groups should plan to arrive Address:___________________________________________________________________________
between 5:00 and 6:00pm. Check-out time is 6:30pm Friday, June 11th.
City:_________________________________ State:___________ Zip:_________________________
Cost:
Early Bird registration is $115 and must be postmarked or turned into the office before May Phone:_______________________________________________ Sex: M F
17th. Additional kids from the same family will receive a $10 discount. Late registration will Church:____________________________________________________________________________
incur an additional $20 late fee (per child). We cannot guarantee spots after May 17th. No
additional funds will be needed at camp, all items are included in the session fee. T-shirt size: (adult sizes) S M L XL XXL

Camp Staff: Medical Conditions or concerns:_________________________________________________________


The camp is staffed with food service personnel, trained counselors and junior counselors,
medical staff, and certified lifeguards. Head Counselors are at least 20 years old and have Emergency Contact:__________________________________________________________________
Phone:__________________________________________________________________
undergone background checks. Junior Counselors are current high school students who have
attended intense training. All camp matters go through our directors, Jerred England, Kent Friends you would like to room with:_____________________________________________________
Brown, Ryan Russell and Nathan Frisk.
Wellness Policy:
In order to keep everyone healthy, we will not admit campers who have the following Enclosed is: _______ $115 Early-bird fee (before May 17th)
symptoms: a fever of 99 or higher in the last 24 hours, a runny nose, eye drainage, coughing, _______ $105 Second child discount
diarrhea, vomiting in the last 24 hours, head lice, or those who have started antibiotics in the _______ $95 Any additional child discount
_______ $135 Regular Fee (after May 17th)
last 24 hours. If a child has a non-contagious condition, but has the above symptoms, please
let us know.
Make checks payable to: Del City Church of Christ
Medication Policy: Tear on dotted line and return this half of the form to:
Over-the-counter and prescription medications brought to camp MUST be turned in to the camp
nurse at time of check-in. Prescription medications should be in the original bottle with only the Camp Rock Creek
Del City Church of Christ
amount needed for the child’s length of stay. All prescription bottles should be placed in a
1901 Vickie Drive
Ziploc bag with the camper’s name written on it and will be administered by the camp nurse. Del City, OK 73115
Security & Phone Information:
We are fully aware of our great responsibility in the care of your child. All visitors need to be
Medical Release
approved and must schedule their visit between 7:00pm and 9:00pm for evening chapel service In case of an emergency, you will be contacted as soon as possible. Our insurance carrier requires that we have this information on file. Thank you
only. In case of emergency you will be notified immediately. Out of consideration for other for your assistance in this matter.
Participants name:__________________________________________________ Age:______________ Date of birth: __/___/____
campers and planned activities, incoming calls are not allowed except in case of emergency.
Should campers need to contact parents, calls can be made through a camp director. Please Insurance Company: ________________________________________________ Policy Number:___________________________
DO NOT send cell phones to camp with your camper. Unauthorized cell phones will be Beginning with the date signed by the undersigned through June 11th, 2010, the undersigned does hereby give permission for an
confiscated and held by the directors until check-out on Friday. authorized representative of the Del City Church of Christ Rock Creek Camp Session to consent to any medial attention under the
advice of a physician or dentist licensed under the provisions of the Medial Practice Act on the medical staff of a licensed hospital.
The undersigned shall be liable and agrees to pay all costs and expenses incurred in connection with such medical and dental services rendered to the
What Do I Bring? aforementioned child.
Bible and notepad sleeping bag & pillow bathroom items The undersigned does hereby release, forever discharge and agree to hold harmless the Del City Church of Christ and its authorized representatives
swimsuit medications you take towel thereof from any liability, claims, or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatso-
ever which may be incurred by the undersigned and the child that occur while said child is participating in any activity sponsored by the church.
non-menthol shaving cream flashlight Furthermore, I hereby assume risk of personal injury, sickness, death, damage and expenses as a result of participation in activities involved therein.
modest clothes (shorts must be 2” above the knees)
The undersigned does also hereby give permission for our child in emergency situations to ride in any vehicle designated by the adult in whose care
the minor has been entrusted while attending and participating in activities sponsored by the Del City Church of Christ
What NOT to Bring? and its authorized representatives.
weapons drugs or alcohol tobacco products Signature of Parent/Guardian________________________________ Date__________________________
cell phones radios CD players
fireworks walkie talkies MP3 players
portable game systems immodest clothing
Make sure to complete other side of this form before sending in.

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