Camp Celebrate 2021

ACKNOWLEDGMENT OF RISKS. COVID-19 is a highly contagious virus. While the Parish is taking steps to create a safe and healthy work environment, you help to reduce the risk of spreading COVID-19 by complying with the Parish’s directives that are set forth below. By completing the form below you acknowledge the risk of contracting COVID-19 or other communicable diseases while present at the Parish and during Parish sanctioned events and agree to follow the Parish’s directives outlined by the event details.

Camper Information

Name

Nick Name

If you can NOT select your grade in the registration category, that means a wait list has started for that grade/gender. Please do not continue to fill out the rest of the form, but instead go fill out the waitlist here:
WAIT LIST Spots will be filled from the waitlist on depending on who singed up first.

T-Shirt Size (Adult Sizes)

School

Address

Cabin-mate REQUEST: Fellow camper of same sex and grade; THESE ARE NOT PROMISED, due to possible space issues

Dietary Restrictions or Food Allergies

Parent Information

Mother's Full Name

Mother's Cell Phone

Father's Full Name

Father's Cell Phone

Emergency Contact In Case Parents Cannot Be Reached (Name & Number)

For some reason Outlook cannot send emails to WINDSTREAM email accounts (they ALL bounce back as spam). If you would like to ensure delivery of all email updates from Camp Celebrate, please enter an email address that is NOT @windstream

Parent Email

This address will receive a confirmation email

Second Parent Email

Consent Form, Photo Release and Medical Waiver

I, the parent or lawful guardian of (the “child”), give permission for my child to participate in the St. Mary Camp Celebrate activity described further on the Activity Information in the discription of this event (the “Activity”) sponsored by St. Mary Parish (the “Parish”). In exchange for and in consideration of the opportunity for my child to participate in the Activity, I agree to the following:

1. I understand what is involved in the Activity and acknowledge that I have had the opportunity to ask questions regarding the scope and nature of the Activity. I recognize the possibility and risk of injury associated with my child’s participation in the Activity and that such injury can include, but is not limited to, pain, suffering, serious bodily injury, psychological injury, temporary or permanent disability, temporary or permanent paralysis, illness, disfigurement, further injury by medical treatment, and/or death. I understand that such injuries can occur for any number of reasons which are both foreseeable and unforeseeable and which include, but are not limited to, my child’s own actions or inaction, the actions or inaction of others (whether negligent, intentional, or otherwise), and equipment failure.

2. I further understand that my Child’s participation in the Activity is purely voluntary and is a privilege and not a right, and that my Child, and I on behalf of my Child, agree to my Child’s participation in the Activity in spite of the risks. I and my spouse assume, for ourselves and on behalf of our minor child, all risks in connection with my child’s participation in the Activity.

3. I agree to instruct my child to cooperate with those persons in charge of the activity. I understand and agree that, in the event my child does not cooperate with the person(s) in charge of the activity, which shall be determined at the sole discretion of the person(s) in charge of the activity, I agree to cooperate with the Parish in picking up my child to remove them from the activity.

4. To the fullest extent allowed by law, I, on behalf of myself, my spouse, my minor child, as well as our respective heirs and assigns, executors, all other legal representatives and any others claiming through us or on behalf of us, hereby agree to release, discharge, hold harmless and indemnify the Parish, the Roman Catholic Diocese of Cleveland, the Bishop of the Roman Catholic Diocese of Cleveland, as well as their respective clergy, officers, employees, agents, representatives, attorneys, sponsors, and volunteers (“Released Parties”) forever from and against any and all claims, lawsuits, damages, judgments, expenses including attorney’s fees, liabilities (of any nature or extent), demands, damages, cause of action of any nature and kind, known or unknown, which in any way arise out of or relate to my child’s participation in the Activity (including without limitation any injury, loss, or damage to my child’s person or property), whether foreseen or unforeseen, regardless of the cause (including, but not limited to, the negligence of any person) (the “Claims”).

5. I understand that it is my responsibility to carry appropriate medical insurance for my child and that such is not the responsibility of any other person or party, including, without limitation, the Parish or the Diocese of Cleveland.

6. In the event reasonable attempts to contact me at the number listed below have been unsuccessful, I hereby authorize any of the staff, employees, volunteers, agents and/or representatives of the Parish to provide for, seek, and authorize medical treatment for my child in the case of illness or accident from the closest and most appropriate licensed medical practitioner or hospital available. I understand that this authorization does not cover major surgery unless the medical opinions of two licensed physicians/dentists concurring in the necessity for such surgery are obtained for the performance of such surgery.

7. I consent and grant permission for the Parish and/or its agents to record (in writing or otherwise), photograph, audio record, and video record my minor child’s name, image, likeness, spoken words, in any form (the “Recordings”), and to display, release, exhibit, publish, or distribute the Recordings, or any part thereof, for the purpose of and in connection with any material that may be created by or on behalf of the Parish including, without limitation, through the Parish’s bulletin boards, social media, website, print and electronic media, marketing publications, public relations and communications materials and/or presentations, and any other uses as may not be contemplated herein, without further notice or compensation, and I agree that the Recordings shall constitute the sole property of the Parish. I further agree to release the Parish, the Catholic Diocese of Cleveland, and the Bishop of the Diocese of Cleveland, and their respective officers, directors, agents, employees and/or attorneys from and against any and all liability, loss, damage, costs, claims, and/or causes of action arising out of or related to the above items to which I have consented. I further understand that the Parish and its respective officer, directors, agents and/or employees have no control over use of photographs, videotapes, audiotapes, or other records made by others and/or outside the scope of this consent and release.

8. To the fullest extent allowed by applicable law, the Agreement shall be binding upon and inure to the benefit of the parties and their respective heirs, administrators, personal representatives, executors, successors and assigns. I, on my behalf and on behalf of my minor child, have the authority to release the Claims and have not assigned or transferred any Claims to any other party. This Agreement constitutes the entire agreement between the parties and supersedes any and all prior oral or written agreements or understandings between the parties concerning the subject matters of this Agreement. This Agreement may not be altered, amended or modified, except by a written document signed by both parties. The Released Parties, to the extent they are not parties to this agreement, are intended to be third party beneficiaries.

8. This acknowledgement and release is intended to be as broad and inclusive as permitted by the law of the State of Ohio, and if any portion hereof is declared invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. This acknowledgement and release shall be construed in accordance with the laws of the State of Ohio, except for the choice of law provisions thereof.

I give my permission for my child to attend the Activity and agree to all terms and conditions stated above.

Yes No

By typing my name below, which shall constitute my electronic signature, I acknowledge that I am the parent or legal guardian of the child(ren) named in this form and have the authority to sign this document and act on his/her or their behalf. I agree that my electronic signature is intended to authenticate this writing and to have the same force and effect as my manual signature.

Today's date

Please provide any additional information about the participant's behavior and physical, emotional, or mental health about which the camp should be aware (e.g. susceptibility to related issues such as passing out or bad headaches, frequent nosebleeds, recent family crisis or severe emotional stress).

This person takes medications on a routine bases (includes over-the-counter or non-prescription drugs)

Yes No

Please list ALL medications (including over-the-counter or non-prescription drugs) taken routinely. Bring enough medication to last the entire time at camp. Keep it is the original packaging/bottle that identifies the prescribing physician (if prescription drug), the name of the medication, the dosage, and the frequency of administration. Be away that ALL medications MUST be kept locked in the nurse's station.

If yes, please list EACH medication, dosage, time to administer, reason for taking and any special instructions below

Healthcare Insurance Carrier is:

Name and Number of the Insured

Policy No.

The following non-prescitpion medications may be stocked in the camp nursing station and are used on an as-needed basis to manage illness and injury. Please type, in the box below, those medications that the child should NOT be given:

- Antihistamine/Allergy Medications (loratadine [claritin], diphenhydramine [benadryl])
- Tums
- Acetaminophen [tylenol]
- Ibuprofen [advil, motrin]
- Cough Drops
- Vaporub
- Antiobiotic Ointment
- Hydrocorisone Cream
- Lanacane Cream [for poison ivy]
- Aloe Ointment
- Cough Syrup [robitussin]
- Decongestant [sudafed]
- Poison Ivy Wash

Please do NOT give ANY of the medications above Check Here for NO

Any medications from this list above that my child should NOT be given

CAMP Y-NOAH CAMP & OUTDOOR PROGRAM WAIVER

I understand my child may be involved in activities at camp that include but are not limited to horseback riding, challenge course, boating, and outdoor activities. I acknowledge that my child may decline to participate in any activity. Any participation will be voluntary. In consideration of services or property provided, I, for myself and any minor children for which I am parent, legal guardian or otherwise responsible, any heirs, personal representatives or assigns do hereby release: Akron Area YMCA, YMCA Camp Y-Noah, its directors, officers, agents, employees and volunteers, from all liability and waive any claim for damage arising from any cause whatsoever (except that which is the result of gross negligence). Further I give my consent for YMCA Camp Y-Noah to provide transportation to and from Day Camp pickup/drop off sites and off camp activities. I authorize the YMCA to take and use any photographs, comments, and videos of my child for promotional purposes.

Name of Participant

Today's Date

CAMPER STATEMENT OF RESPONSIBILITY (campers only)

I promise to enter into camp life with enthusiasm, trying to give my best self in the spirit of Christian community. I promise to obey camp rules and cooperate with the Camp Celebrate staff for the interest and safety of all. I understand and accept the "3-stike" policy wherein after 2 strikes for discipline issues, the director and I sit down and call my parents. After 3 strikes, I will be required to leave camp. I also understand that in the case of severe breaking of rules, some actions may fall under a "zero-tolerance" policy and I may be asked to leave camp immediately.

Camper Signature

Parent Signature

Today's Date

COUNSELOR/STAFF STATEMENT OF RESPONSIBILITY (counselors/staff only)

I intend to be an upstanding Christian role model for my campers. I will take my position seriously and responsibly, conducting myself in a mature manner appropriate for individuals younger than me, participating fully in all camper activities, fulfilling my required schedule assignments, aking all campers feel welcome and special, and following all rules of both Camp Y-Noah and the Church. These rules will include appropriate dress, curfew, assigned cabin duty and meal duty, no overnight gatherings, etc. I understand that the sole purpose of this camp experience is to bring the teachings of Christ to 6th-8th grade young people who look to me for guidance and as examples. I am willing to devote my week to the ministry of bringing these individuals closer to God in every way possible. I understand that in the case of severe breaking of rules, some actions may fall under a "zero-tolerance" policy and I may be asked to leave camp immediately.

Counselor/Staff Signature

Parent Signature (If Under 18)

Today's Date

Payment

Registration

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Camp Celebrate 2021

Description

Please Fix the Following