Christian Conference Center
Winter Youth Retreats
'" I Can Do All Things through Christ!"
"Medication" is any substance a person takes to maintain and/or improve their health. This includes vitamins and natural remedies. All medications are collected, stored, and distributed by camp health care personnel. Please list ALL medications (including over-the-counter or non-prescription drugs) taken routinely. Bring only enough medications to last the entire time at camp. Keep it in the original packaging/bottle that identifies the prescribing physician (if a prescription drug), the name of the medication, the dosage, and the frequency of administration.
You will be contacted if:
The undersigned person represents that he/she is the custodial parent/legal guardian of the above identified participant. The camper has my permission to attend this session of camp at the Christian Conference Center. This permission is given by me with full knowledge of the conditions and activities contemplated during each session (see uppermidwestcc.org for more information). The participant has no physical or mental disabilities that would impair their participation except as noted above. I acknowledge, agree to, reconfirm, and incorporate herein by reference the Release of Liability signed by me which is attached hereto. I also understand that the information provided on this form will be kept confidential and shared only as necessary to provide care of the participant.
I understand that camp insurance is a supplemental policy only. It will pay whatever my own insurance does not cover (deductible or over) up to the limit of the policy. If medical (sickness. injury) care is needed, billing will be sent to the parent/guardian who will be responsible for direct payments to physician, hospital, clinic, etc.
The participant is currently taking only medications listed above. The camper has no allergies known to me except as noted on this form. The health information/history is correct as far as I know. In the event of illness or injury, I authorize the camp, physician, and/or hospital to undertake such treatment of and perform such services (including surgical) for the participant as are reasonably indicated by the circumstances.
Unless checked below, I accept that the participant/s likeness may be used in any online or print publications or social media by the Christian Conference Center and/or the Christian Church in the Upper Midwest.
I have read and understand the Covid-19 information provided on this form, and I agree to instruct my camper to follow health and safety protocols that are required by the Christian Conference Center for participation. I understand that a full list and description of required health and safety measures will be provided to me and my camper at least 2 weeks before my camp session. I understand that if my camper refuses to follow these protocols while at camp, my camper may be sent home early from the event.