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Page 1: 2017 Group Leadercentrikid.s3.amazonaws.com/centrikid/files/2016/12/Campbellsville-Weekend.pdfweeks before camp starts.) You will receive an email with your housing specifics. If you

2017GroupLeaderinformation

Page previewLocation Specifics ... 1-4

Pre-Camp Info ... 5-8Forms ... 9-13

Page 2: 2017 Group Leadercentrikid.s3.amazonaws.com/centrikid/files/2016/12/Campbellsville-Weekend.pdfweeks before camp starts.) You will receive an email with your housing specifics. If you

contact infoCamp Director: Kaleb SmithAssistant Director: Betsy LyleCamp Phone: 615.657.9252Camp Email: [email protected] (You will send your participant list to this email address at least 3 weeks before camp starts.)

You will receive an email with your housing specifics.If you haven’t heard from us 5 days before camp, or if we’ve been playing phone tag, please email us at [email protected].

HousingHousing is dorm style for boys and girls (2 per room) with bath on hall. One of the boys’ dorms is a little different, with 4 individual bedrooms and a shared bathroom. All beds will be twin size. There are some situations where there may be 3 per room. If this is the case, you will be aware of this before your arrival at camp.

Towels and linens are NOT provided. You might want to bring hand soap, paper towels, shower shoes, and a bathmat.

Housing will be determined when we have received participant lists for the groups attending camp for the week. Please make sure to send in your participant list 3 weeks before camp!

letters from homeATTN: CentriKid CampsCamper / Church Name1 University Dr.UPO 883Campbellsville, KY 42718

Make sure you send all mail by Day 2 of camp, so that it gets to camp before your camper leaves!

campus informationWebsite: www.campbellsville.eduTime Zone: EasternDuring Check-In, you will receive keys to the rooms you’ll stay in for the week of camp. If keys are lost, they are $25 to replace.

Ca

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1

Page 3: 2017 Group Leadercentrikid.s3.amazonaws.com/centrikid/files/2016/12/Campbellsville-Weekend.pdfweeks before camp starts.) You will receive an email with your housing specifics. If you

Archery

soccer

Splish Splash

Baseball

Basketball

Tennis

volleyballFla

g Fo

otba

ll

Outdoor games

wet & wildAdventure

art studioDrama

Weir

d S

cien

ce

Creative DanceKitchen Chaos

build itno boys allowed

Sign Language

cheernastics

Tell the

Bla

st

Worldtrack times track times track times track times

track times

tracktimes

• Archery - Learn how to shoot a bow & arrow and even practice on our foam targets

• Art Studio - A combination of painting, sculpting & crafting

• Baseball - Learn various skills, drills & games of baseball

• Basketball - Learn various skills, drills & games of basketball

• Build it - Creative hands-on building activities

• Cheernastics - A combination of cheerleading & gymnastics

• Creative Dance - Learn a creative movement and perform in front of camp

• Drama - Learn what it means to be an actor and perform various skits

• Flag Football - Learn various skills, drills & games of football

• Kitchen Chaos - Cook and create fun foods from various ingredients

• No Boys Allowed - A girls-only indoor track with discussion and activities

• Outdoor Games - Play some favorites like wiffleball, capture the flag & ultimate frisbee

• Sign Language - Learn the basics and perform a song through sign language in front of camp

• Soccer - Learn various skills, drills & games of soccer

• Splish Splash - Fun and crazy games in the pool

• Tell the World- Learn about missions and how you can play a part in the Great Commission

• Tennis - Learn various skills & drills of tennis

• Volleyball - Learn various skills & drills of volleyball

• Weird Science - Fun experimental games & activities with safe ingredients

• Wet & Wild - An assortment of games involving water hoses, water balloons, etc.

* Tracks are subject to availability. Make sure campers know the sports tracks are for beginner to intermediate players. We will be teaching basic skills for each sport, so if you have an all-star, you might want to encourage them to try something new!

track time descriptions

2

Page 4: 2017 Group Leadercentrikid.s3.amazonaws.com/centrikid/files/2016/12/Campbellsville-Weekend.pdfweeks before camp starts.) You will receive an email with your housing specifics. If you
Page 5: 2017 Group Leadercentrikid.s3.amazonaws.com/centrikid/files/2016/12/Campbellsville-Weekend.pdfweeks before camp starts.) You will receive an email with your housing specifics. If you

Campbellsville University is a small campus in a quiet town. Our contacts at Campbellsville University are the best of the best and will do whatever it takes to meet your needs, normally before you even know you need something!

As soon as you enter campus, you will see CentriKid flags and staff in matching CentriKid shirts pointing you to where you will need to go for Check-In.

What to eat & where to hang outWi-Fi is available campus wide. Books n’ Beans will be a greats spot for adults to hang out, check email, and just have a few quiet moments. You also will get a really great map/camp guide when you arrive on campus for Check-In! The Recreation field is conveniently in the center of campus and all classroom space is close. We will be the only large camp on campus throughout the week!

The Davenport Student Commons houses a Starbucks, Chick-fil-A, and a small computer area. There also is a campus book-store in that building that sells drinks, candy, and other items that campers can take advantage of during Hang Time.

Baseball

The Spot

REC FIELD

FOOTball fieldfootball/soccer

track times

Wet and wildtrack

Indoor practice

field

tennis

powell athleticcenter

basketball/pool

The village

The village

outdoor tracksvolleyball

archery

b. study rooms

druienhall

stapp hall

northhall

Student activity center

cheernastics

carter HallScience

building

Alumni building

ransdellchapel

audi/ camp store

wintersdining hall

(cafe)davenportstudent commons

BooksN’

Beans

South hallwestMen’s Village

South halleast

1

2

6

7

5

3 4

7

89

16

10

1112

13

14

15

CAMBELLSVILLE University Map

stapp Hall4

The Village1 South hall east5

the village2 south hall west6

North Hall3 Men’s Village7

10

indoor practice field

powell athletic center

druien hall

student activity center

7

9

10

science building

carter hall

11

12

13

davenport student commons

winters dining hall

14

15

Buildings to know

8 ransdell chapel16

Housing

alumni building

Check In

b. study rooms

b. study rooms

b. study rooms

Chik-fil-a

4

Page 6: 2017 Group Leadercentrikid.s3.amazonaws.com/centrikid/files/2016/12/Campbellsville-Weekend.pdfweeks before camp starts.) You will receive an email with your housing specifics. If you

Weekend SCHEDULE

3rd=Yellow

4th=Green

5th=Blue

6th=RedAdult=Orange

entering & completed

completed

completed

completed

Encourage your campers to wear their color to OMC. Their grade is the one they just completed.

They will want to have a shirt that is their color for OMC! They can be purchased in the store or they can bring one from home.

wear your color

theSpot Meetat theSpotclose toed ShoesBible

Day 1Check In . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3:00–5:00 pm

Store Open

Dinner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5:30Opening Celebration/Worship . . . . . . . . . . . . . . . .7:00 Team Time (Bible Study) / Adult Gathering . . . .7:45Church Group Time . . . . . . . . . . . . . . . . . . . . . . . . . . .9:00Evening Hang Time

Store Open

Head to Room . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10:00Lights Out . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10:30

Day 2Breakfast // Time Alone with God . . . . . . . . . . __________I Can’t Wait . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8:30 Team Time (Bible Study & Rec) . . . . . . . . . . . . . . . . .9:00

Rotate @ 10:00

Lunch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . __________Track A ________________ . . . . . . . . . . . . . . . . . . . .12:15 SPOTTrack B ________________ . . . . . . . . . . . . . . . . . . . .1:15 SPOTTeam Time (Bible Study & OMC Prep) . . . . . . . . . .2:15 SPOTOMC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2:50Hang Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4:00

Store Open

Dinner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . __________Worship . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7:00Church Group Time . . . . . . . . . . . . . . . . . . . . . . . . . . .8:00Evening Hang Time

Store Open

Head to Room . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10:00Lights Out . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10:30

Day 3Breakfast // Time Alone with God . . . . . . . . . . __________Team Time (Bible Study) . . . . . . . . . . . . . . . . . .8:30 SPOTAdult Gathering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8:45Closing Celebration . . . . . . . . . . . . . . . . . . . . . . .9:45Churches Depart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10:30

5

Page 7: 2017 Group Leadercentrikid.s3.amazonaws.com/centrikid/files/2016/12/Campbellsville-Weekend.pdfweeks before camp starts.) You will receive an email with your housing specifics. If you

FEbruary 15: $50 deposit dueA $50 deposit for each individual reservation is required. Lost deposits are non-refundable and cannot be applied toward the remaining balance due. Many churches collect monthly payments for camp from their parents, do fundraisers to cut costs, and have sponsorships through their church to help aid parents. Fundraising normally begins even before this deposit deadline. Many churches require the $50 deposit from parents when they sign their children up to go to camp.

May 1: Cancellation DeadlineAll cancellations after May 1 will incur an additional $50 fee for each person dropped. When this occurs, deposits cannot be applied toward your balance, so make any changes before May.

recruit sponsorsBring 1 male sponsor for every 5 male campers and 1 female sponsor for every 5 female campers. You may bring students to be in the Team Assistant Program. The cost is the same for Team Assistants as other participants. All sponsors must:Be at least 18 years old (unless part of the Team Assistant

Program) and have a completed background check.

no later than 3 weeks before camp: Pay Balance Final balance must be received 14 days prior to arrival at camp. If it is not, your group will be charged a one-time $75 late fee. Call us at 1-877-CAMP123 about auto-pay options for LifeWay accounts or to put your balance on a credit card.Email your participant list to your camp email address . We can’t do housing until we receive this. Be sure to include correct male and female numbers (including sponsors) and let us know if there are specific campers who do or do not need to be in the same Bible study group.

Prepare Your forms (click for partiicipant list)Turn in at Check-In (in this order): » Notarized Release Form (for campers and adults --

found in Parent Packet) » Track Time Cards » Special Attention Cards » Statement of Compliance

» Group Order Summary

Camp Nurse (click for camp nurse form)You can bring a certified RN or doctor with your group to act as the Camp Nurse for the week. Their spot is free. We only need one nurse per cycle of camp so sign up now at [email protected]!

Travel and ComplianceYour church group is responsible for background checks of Adult Leaders and signing the “Statement of Compliance” in this document. Remember to have the church’s insurance and needed info for travel. The church is liable on the way to and from camp.

Campers without personal insuranceIf a camper requires medical attention while at camp, the camper is responsible for the cost. If the camper does not have insurance, the sponsoring church will be the financially responsible party. If the medical attention is needed because of an accidental injury at camp, LifeWay provides a limited insurance policy that applies to those costs. See Camp Director for paperwork and instructions.

Damages and keysYour church group is responsible to pay for damages to any facilites or residence hall caused by your group. You can check out the cost of lost keys at your specific location.

Email us special needsEmail any needs that we should be aware of prior to camp to [email protected]. Please specify if it is a mobility, dietary, housing, or emotional/spiritual need and include the week and location that you will be attending camp. This could be any accommodation for housing, cafeteria, etc.

Illnesses at campPlease do not bring children who are sick to camp. CentriKid will work with group leaders to handle cases of illness on a case-by-case basis. We must ask that campers displaying flu-like symptoms be sent home for the safety of all campers.

Bringing your own kids to campYour kids, younger than the 3rd grade, are welcome to join their parent during programming since they are not allowed to participate in team time or tracks. If they need bed space and meals, the cost is full price. If they need no bed space or meals, there is no charge.

To d0... Centrikid Policies

6

NEW for 2017!missions offering...This summer at camp you will be able to visit the Camp Store to donate money via credit card! The amount you choose to give, as always, is up to you. Credit cards accepted are Visa, MasterCard, American Express, and Discover. We appreciate your willingness to support missions through CentriKid!

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When should you have a meeting?Every group is different. You will probably want to have one around sign up time to promote and answer any questions that parents may have. You will definitely want to have one about two weeks before camp, covering the Parent Packet and getting forms turned in and notarized. You may need to meet with parents somewhere in between those as well.

Subjects to talk about:LogisticsLet them know what time to be at the church to leave and what time you’ll be back. Are you stopping for any meals on the way to camp or the way back? (You may want to take up money from parents for this meal. Each child can have an envelope for their travel meals so they don’t have to worry about saving enough of their camp spending money.)

Parent PacketWalk through the Parent Packet with parents. Tell them about the camp schedule and what color team their camper will be. Remind them to pack a shirt of the camper’s team color for OMC or to send money to purchase a t-shirt at the Camp Store. Share the packing list [make sure to include what type of bedding they need to bring, and don’t let them forget to bring towels!] Also, remind them to write their child’s name on everything! Talk them through how they can begin to pray for and with their kids who are attending camp and how they can start talking to their child about the training of our faith.

track time infoRemember that campers fill out Track Time cards before you get to camp. It may be a good idea to pass out the descriptions to parents, so they can help explain the tracks. You can have the campers fill out Track Time cards on the bus as you’re going to camp, or whenever you choose.

Check gradesTake this time to double check with the parents which grades their children have just completed. We want to have the campers in the correct Bible Study grade when they get to camp.

Contact at Camp Give parents your cell phone number, and also let them know your policy on cell phones and when they could call. There’s time in the schedule during our afternoon and evening hang time they coud use to call. Afternoons are always best! Be sure to give parents the address at camp.

collect store ordersTake up money for any group pictures, DVDs, Camper Care Packages, and Camp Store Cards.

» Group pictures - due on the Night 1 » DVDs [$30] - includes all media shown that week can be ordered before Day 5 of camp

» Camper Care Packages [$30] - includes all team specific items to get campers completely prepared for OMC. Must be pre-ordered by June 1st

» Camp Store Cards - available in increments of $5, $25 & $50.

In the Parent Packet, there is a form that parents can fill out to indicate what they would like to purchase ahead of time [group pictures, DVDs, Camper Care Packages, and Camp Store Cards]. After you receive these forms from them, you will need to fill out this preorder form for the Camper Care Packages and Camp Store Cards. This will help us make sure we have exactly what you need when you get to camp! The preorder form must be filled out before June 1st to guarantee iteams and sizes.

PaperworkAsk a notary to attend your meeting and notarize release forms after parents fill them out. Make a copy of each form before coming to camp. You’ll turn in the original and keep the copy.

Be sure to collect copies of insurance cards for each participant, both front and back on a full-size page.

Guests at CentriKidTo ensure the safety of all of the campers, everyone must follow these guidelines: » At the beginning of the week, inform your Camp Director of any visitors who will be arriving at camp. This is for both safety of the campers and availability of space.

» Upon arrival, guests must call the camp cell phone number to arrange a meeting location to receive their visitor sticker and to sign in. The Director’s number can be found on page 1 of this document.

» Camp Director/Assistant Director can point the visitors in the direction of their church group at that time or arrange a meeting with their church group’s leader.

parentmeetinghelp

7

Page 9: 2017 Group Leadercentrikid.s3.amazonaws.com/centrikid/files/2016/12/Campbellsville-Weekend.pdfweeks before camp starts.) You will receive an email with your housing specifics. If you

team assistantprogramWhat is it anyway?The Team Assistant Program is an option designed to give your most-trusted high school rising juniors and seniors or young college students a behind-the-scenes look at being a camp staffer while they act as a sponsor for your church group. In general, each church that participates brings two Team Assistants, but the number of TA’s brought is ultimately left to the church group leader’s discretion. Middle school students and high schoolers who are not at least rising juniors may not participate.

What Will they do?• Count toward your 1:5 adult to camper ratio and stay with your group.• Attend staff meetings each morning to prepare for the day. • Shadow a Team Leader (camp staffer) during the morning at Recreation.• Help out with tracks in the afternoon.• Get an inside perspective of what serving on camp staff is like, in case they want to apply one day.

How do i sign them up?Register them just as any other camper or adult sponsor. Remember, they must be at least a rising junior or older. Identify them as “Team Assistant” on the Participant List that you turn in 3 weeks prior to camp.

SPECIAL NOTES: Night 1 - Attend welcome meeting with your Rec Leader during adult gathering. Rec Leader will go over talking points and let Team Assistants know their assignments for the week.

Day 2 - Tracks take place at 12:15 and 1:15. At 2:15, Team Assistants should assist with OMC setup. During OMC, Team Assistants can help create energy and excitement!

Day 3 - Eat breakfast with Recreation Leader if possible. Meet with Recreation Leader at 8:45am during the final adult gathering.

Day 2TIME ACTIVITY ASSIGNMENTS7:40am Morning Staff Mtg Regular attendance required Time Alone with God 8:30am I Can’t Wait Greet kids, create energy, etc sit with church9:00am Recreation With assigned rec staffer:

refill coolers, assist rec leader10:50am Rec Ends Help clean up rec, help set up SPOT & track times_______ Lunch Eat with church group12:15pm Track A Assistant Track Leader1:15pm Track B Assistant Track Leader2:15pm OMC Prep Help set up OMC2:50pm OMC Play OMC!4:00pm Hang Time With Church Group_______ Dinner With Church Group7:00pm Worship With Church Group8:00pm Church Group With Church Group8:45pm Evening HT With Church Group10:00pm Head to room With Church Group

8

Page 10: 2017 Group Leadercentrikid.s3.amazonaws.com/centrikid/files/2016/12/Campbellsville-Weekend.pdfweeks before camp starts.) You will receive an email with your housing specifics. If you

Be sure to Pre-Order all Camper Care Packages by June 1st. Click

here to find the Order Form

9

Page 11: 2017 Group Leadercentrikid.s3.amazonaws.com/centrikid/files/2016/12/Campbellsville-Weekend.pdfweeks before camp starts.) You will receive an email with your housing specifics. If you

________________________ _________________________________________

________________________________________________________________

This camper has a need that CentriKid should be aware of:

dietary medical mobility emotional/spiritual

Concerns: _______________________________

________________________________________

________________________________________

________________________________________

________________________________________

________________________________________

Turn completed cards in to the Camp Director or Assistant Director.

________________________ _________________________________________

________________________________________________________________

This has a need that CentriKid should be aware of:

dietary medical mobility emotional/spiritual

Concerns: _______________________________

________________________________________

________________________________________

________________________________________

________________________________________

________________________________________

Turn completed cards in to the Camp Director or Assistant Director.

________________________ _________________________________________

________________________________________________________________

This camper has a need that CentriKid should be aware of:

dietary medical mobility emotional/spiritual

Concerns: _______________________________

________________________________________

________________________________________

________________________________________

________________________________________

________________________________________

Turn completed cards in to the Camp Director or Assistant Director.

________________________ _________________________________________

________________________________________________________________

This camper has a need that CentriKid should be aware of:

dietary medical mobility emotional/spiritual

Concerns: _______________________________

________________________________________

________________________________________

________________________________________

________________________________________

________________________________________

Turn completed cards in to the Camp Director or Assistant Director.

10

Page 12: 2017 Group Leadercentrikid.s3.amazonaws.com/centrikid/files/2016/12/Campbellsville-Weekend.pdfweeks before camp starts.) You will receive an email with your housing specifics. If you

Statement of Compliance: This form is turned in upon arrival at camp. The volunteering Adult Sponsors named below are known to the staff or recognized leadership of the participating church and the church knows of no reason why any should not serve as a sponsor for children and youth under the age of eighteen (18). The church confirms that it has taken reasonable steps to confirm that the individuals are not registered sex offenders by making inquiries to law enforcement officials or by checking www.nsopr.gov (the National Sex Offender Public Website). Participating church warrants that it has used _________________company to perform nationwide criminal background checks on all Adult Sponsors . Participating church warrants it has brought no Adult Sponsor not listed on this form. Names of all Adult Sponsors:

1. _________________

2. _________________

3. _________________

4. _________________

5. _________________

6. _________________

7. _________________

8. _________________

9. _________________

10. _________________

11. _________________

12. _________________

13. _________________

14. _________________

15. _________________

16. _________________

17. _________________

18. _________________

19. _________________

20. _________________

For camps held in Texas, the sponsoring church attests that it has, in addition to the above

referenced sex offender and criminal background checks, satisfied the requirements set forth

by the Texas Department of State Health Services Rule 265.12, which can be found online at

www.dshs.state.tx.us/youthcamp/default.shtm

Church Name: ________________________ Phone #: ___________________

Address: ________________________ City: _______________ ST ____ ZIP _____

________________________ _______________ _________

Authorized Representative Signature Name Printed Date

Revised for 2013 11

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Page 1 of 2 Rev Oct 2013

Participant Form

Group Leaders: Bring ONE notarized copy of this document to registration and keep a photocopy for yourself

to have with you in case of emergency at camp. YOU MUST attach a photocopy of insurance card (front & back).

Church Information: CentriKid Venue: ______________________________ Name of Church: _________________________________ Group Leader: __________________________________ Group Leader’s cell # at camp: (_____)_____________ Church Address:_________________________________ City: ___________ ST: ________ ZIP: _____________ Camper’s Info: Participant Name____________________________________________ Age_______ Date of Birth:___/___/____ Grade Completed (campers only): ______________ Address: ______________________________________City: __________________ ST ________ ZIP__________ In case of an emergency notify:_________________________________ Relationship to participant:_______________________ Phone Numbers - Home: (___)____________________ Work: (___)_______________________

Mobile: (___)____________________ Other:(___)_______________________ Medical Profile Generally, the participant’s Health is: (Check One) □Excellent □Good □Fair □Poor

If Fair or Poor, please explain the condition:_________________________________________________ List any medical difficulties which are currently being treated:___________________________________________ Check any of the following that cause you problems & explain:

□ Asthma □ Sinusitis □ Bronchitis □ Kidney Trouble □ Heart Trouble □ Diabetes

□ Dizziness □ Stomach Upset □ Hay Fever ________________________________________________________ ________________________________________________________ ________________________________________________________

List any medicines or substances to which you are allergic: _________________________________________ List any previous operations or serious illnesses_____________________________________________________ List any medications you are currently taking: ______________________________________________________ List any special diet or special needs:______________________________________________________________ Childhood Diseases: □Chickenpox □Measles □Mumps □Whooping Cough □Other:_____________ Date of Tetanus Immunization: ___/___/___

You MUST attach a photocopy of insurance card (front & back). If a camper requires medical attention while at camp, the camper is responsible for the cost. If the camper does not have insurance the sponsoring church will be the financially responsible party. If the medical attention is needed because of an accidental injury at camp, LifeWay provides a limited insurance policy that applies to those costs.

Permission, Acknowledgements, Release, Indemnity My permission is granted for the camp or event director, church official, any camp or event staffer, or adult present or in charge of first aid, to obtain necessary medical attention in case of sickness or injury to me or my child. Also, I understand that as a Participant, I or my child may be photographed or videotaped during normal camp or event activities, and these photos/videos may be used for promotional purposes. I, the undersigned, do hereby verify that the above information is correct, and I do hereby release and forever discharge LifeWay Christian Resources of the Southern Baptist Convention, the CentriKid Camp Venue, the Church, camp or event sponsors and state conventions and their employees (“Released Parties”) from any and all claims, costs, demands, actions or causes of action, past, present or future arising out of any damage or injury in connection with my or my child’s employment by or participation in this camp or event. I agree to indemnify the Released Parties for any and all claims, demands, damages, injuries, costs, suits or causes of action, past, present, or future, arising out of or caused by myself or by my child while participating in this camp or event or while on property leased or owned by any of the Released Parties.

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Page 2 of 2 Rev Oct 2013

Assumption of Risk. I am aware of the risks associated with participation in the above event and do hereby voluntarily assume full responsibility for any risk of loss, property damage or personal injury, including death, that may result from participation in event activities.

Recreation– The recreation programs at summer event venues strive to offer fun, safe, and challenging activities that engage the whole person—body, mind and soul. Program staff are trained and as a team committed to your rewarding experience with safety as their highest priority. They have done everything possible to mitigate any risks involved in their recreation programs. However there are inherent risks to participation in recreation activities, including but not limited to, initiative games, high and low challenge course, outdoor education, paintball and aquatics (not available at every CentriKid venue). You could experience any of the following – elevated heart and respiratory rates, uncomfortable group dynamics, climbing or descending unpredictable and possibly slick or uneven terrain, crossing narrow wires and logs, jumping, running, climbing/descending steep rock faces, traveling long distances in remote settings, carrying weight on your backs and shoulders, unforeseen forces of nature or weather, any of which could result in injury/illness that could result in loss of life, limb, and/or property. For more detailed information about the recreation programs offered at CentriKid Camp Venues, go to www.lifeway.com/centrikid and follow the specific link to the camp venue’s Group Leader Information.

Understanding. I represent and acknowledge that I have completely read and understand this document and all its terms and all matters referred to herein, and I signed voluntarily as my free act and deed, that I have had an ample opportunity to obtain the advice of counsel and that, by signing this document, I understand that I am relinquishing legal rights and remedies that may have otherwise been available to me. I understand that this Waiver and Release shall be construed as broadly and inclusively as is permitted by applicable law and agree that if any portion of this document is held invalid, the remaining shall continue in full force and effect. To the extent the restriction on filing lawsuits is deemed unlawful, I agree to submit any Claims to a Christian conciliation/mediation organization for binding resolution.

Affirmation. Participant affirms that he/she has not been convicted of nor received a deferred adjudication for: a misdemeanor or felony under any state or federal statute regarding crimes against persons, sexual offenses, or violent offenses under the “Participant Name” submitted on this document or any other name or alias.

Copy to Camp Venue. It is understood and agreed that a copy of this form shall be treated as authentic and binding as the original and that a copy of same shall be provided to camp venue.

Complete and sign below (participants who are minors per your state statute require Parent/Legal Guardian signature). Participant’s Signature: (only if 19yrs of age or older) Date: ___/____/___ Parent/Guardian Signature: Phone: ( ) Date:___/___/___ Notary Acknowledgement: State of County of On __________ before me, , Notary Public, personally appeared ______________________________________________________________________________ who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the state that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Notary signature:

My commission expires: