In this section, please enter the camper's information.
This is the student's phone number, if applicable.
Please list any allergies that this camper has below
This is the parent/guardian that the child primarily lives with.
Please note that all important information will be dilvered via email. Please list an email that you check regularly.
Must be someone other than primary parent/guardian and must be available during event, in case the primary contact can not be reached.
Due to the limitations of our medical volunteers serving at Beaverton Foursquare camps, retreats or missions trips, we will only be able to accept students with injectable medicine or pumps if a parent or legal guardian attends the event with them and is willing to provide oversight and responsibility for the maintenance of these needs while at camp. PLEASE NOTE THAT EPIPENS DO NOT COUNT AS INJECTIBLE MEDICATION. If you would like more information about how we can help to make this accommodation possible for you and your child, please contact the ministry leader as soon as possible. Thank you for helping us maximize our time in caring for families.
Please describe in enough detail to be useful to our medical staff/volunteers. This information will only be used by medical staff/volunteers.
For the following questions, if there is no medical coverage for the camper, please type NA in the boxes.
Consent and Release
I have read and I agree with the Permission, Consent, & Release outlined below.
I give permission for my child to attend this Beaverton Foursquare Church event. I understand that my child’s participation in the event will involve inherent risks and I hereby voluntarily assume those risks on behalf of my child. I hereby release the Church, its pastors, employees, agents, and volunteer workers from and against any and all claims and liability for any injury, loss, or damage to person or property that arise out of or relate to the event.In the event of illness or accident I hereby consent and authorize the camp staff, or sponsor acting on behalf of the church, to provide emergency medical care as advised by the camp nurse, local medical staff, or hospital. Including any X-ray examination; injections; anesthesia; medical, dental, or surgical diagnosis and treatment; and hospital care and treatment advised and supervised by physician, surgeon, or dentist (as appropriate), licensed to practice under the law of the state where the services are rendered, either as an outpatient or in any hospital. I understand that as the parent or guardian of my child my own personal medical and hospitalization coverage will be considered primary coverage, and that the Beaverton Foursquare Church carries secondary medical insurance coverage, which, consistent with the exclusions, limitations, and terms thereof, may provide benefits to my family. I agree to apply first for benefits from the personal and hospitalization coverage available to my family, if any, before applying for benefits that may be available through the church's medical insurance coverage. To the best of my knowledge, I have listed all my child's medical allergies, medications being taken, medical problems, and other pertinent information. My child has permission to participate in all prescribed activities except as noted by me.
By participating in this activity, I give Beaverton Foursquare Church permission to record my child's photograph/video image or voice and grant Beaverton Foursquare Church all rights to use any such recordings for educational, promotional, advertising, or other non-commercial purposes that support the mission of the Church. I agree that all rights to these recordings belong to Beaverton Foursquare Church.