Release Time Registration | Venango | Venango UMC

CVFJ Registration

You must submit each camper's registration separately

Camper's First and Last Name

Is This Your First Time at CVFJ?

Yes

Home Church (if applies)

Home Phone

Street Address

PO Box/Apt

City

Region/State/Province

Postal / Zip code

I hereby give permission for my child to participate in swimming and water activities as indicated above while at Camp Venango for Jesus. (If you desire your child to wear a life jacket when swimming in the pond – you must provide it.) I understand a lifeguard will be present for the activities and it will take place at the ponds on the private residence of Keith Boyd.

Grade Entering

Date of Birth

Parent/Guardian Names

Work Phone(s)

Insurance Company

Family Physician

Sex

Male

Female

T-Shirt Size (Adult sizes only)

Parent/Guardian Email

Cell Phone(s)

Insurance Policy & Group Number

Allergies/Health Concerns

Comments

SWIMMING (A lifeguard will be present.)

Swimmer with no life jacket required

Swimmer with life jacket only

I do not want my child to swim

I hereby give my permission for my child to attend Camp Venango for Jesus 2023. I give permission that he/she may be transported off the premises for pre-planned camp activities and agree to all camp policies. I also permit that a photo of my child be used for camp publicity. In case of medical emergency, I give consent for emergency treatment by adult personnel. I understand Venango Methodist Church, Keith Boyd and family, other staff/volunteers, and Camp Venango for Jesus assumes no liability for accidents which may occur while at camp.

Scholarship Code

CANOEING/KAYAKING/RAFTING (A lifeguard will be present.)

Yes, my child may participate in canoeing, kayaking and rafting activities.

No, I do not want my child to participate

To the fullest extent permitted by law, the undersigned, individually and as parent and natural guardian of his/her/their minor child (hereinafter the “CAMPER”), and for the undersigneds and the minor’s representatives, executors, administrators, successors and assigns, do hereby agree to indemnify, defend and hold harmless CAMP VENANGO FOR JESUS (hereinafter referred to collectively as “CAMP”), its servants, agents, officers, directors, members, shareholders, employees, staff, volunteers, successors and assigns, from and against all claims, demands, damages, liabilities, causes of action, losses, costs and expenses, including reasonable attorney’s fees, of every kind and nature, whether or not covered by insurance, arising out of, resulting from or caused by, in whole or in part, any act, omission, fault or negligence on the part of the CAMP, its servants, agents, officers, directors, members, shareholders, employees, staff and/or volunteers, as well as any act, omission, fault or active or passive negligence on the part of CAMP, its servants, agents, officers, directors, members, shareholders, employees, staff and/or volunteers, in connection with this Agreement, including but not limited to those claims, demands, damages, liabilities, causes of action, losses, costs and expenses attributable to bodily injury, sickness, disease or death, or to injury to or destruction of tangible property including the loss of use resulting therefrom. This obligation to indemnify, defend and hold harmless shall not be construed to negate, abridge or otherwise reduce any other right or obligation of indemnity which would otherwise exist as to any party or person described in this paragraph. Further, this obligation to indemnify, defend and hold harmless shall survive termination of this Agreement.

Thanks for submitting!

CVFJ Registration

*You must submit each camper's registration separately*

You must submit each camper's registration separately