Box N-3199 * Nassau, Bahamas 1811 NW 51st ST. * # 1165 * Ft. Lauderdale, FL 33309

(954) 681-4692 (U.S.) * (242) 323-6202 (Bahamas) Fax: (242) 356-3712 (Bahamas)

E-mail: evangelistkselver@hotmail.com

2009 MEDICAL AND LIABILITY RELEASE

(RETURN WITH PARENT’S SIGNATURE ASAP) CAMPER’S NAME ___________________________________________ AGE_______ M F BIRTH DATE________

Please PRINT Last Name First

ADDRESS________________________________________________________________________________________ Street, City, State/Province, Zip, Country

IN EMERGENCY, NOTIFY (NAME) ___________________________________________________________________ Relationship to Camper

PHONE: (_____)___________________ (_____)____________________ (_____)___________________ Home Work Cell

FAMILY DOCTOR: _________________________________________ DR.’S PHONE: ___________________________ CHURCH NAME: ________________________________________________ CAMP DATES ___/___/___ - ___/___/___ DATE OF LAST PHYSICAL EXAM____________ T-SHIRT SIZE: Youth Sizes M L Adult Sizes: S M L XL XXL WAIST SIZE (GIRLS ONLY) _______ HEALTH HISTORY—CONFIDENTIAL

Last Tetanus Shot ___/___ Allergies: Drugs/Insect Stings/Food Asthma: Nebulizer? Y/N Swimming Restrictions? Y/N Diabetes: Insulin Dependent? Y/N Physical Handicap Heart Condition Epilepsy/Seizure Disorder Nervous/Mental Disorder Bedwetting Other (please specify) ________________________________________

Please describe any condition listed above in the space provided. Prescription medications in original labeled containers must be checked by the Nurse/First Aid Provider at camp check-in. Note: Camp Elienai can only administer medication with written parental permission and specific instructions written below or on reverse of this form. ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ Medication(s) Name (Use Reverse Side if Needed) Dose(s) Times If you have medical insurance, your carrier will be billed for medical charges in case of illness while at camp. Do you want to use the camp’s insurance (British American)? � Yes � No Do you have medical insurance? � Yes � No Please complete information below and attach a copy of both sides of any insurance cards: Primary Insured’s Name: ___________________________________________ Policy No.______________________ Insurance Company: ______________________________________________ Group No. ______________________ MEDICAL RELEASE In the event of an emergency during the camp dates as shown on this form, I hereby give my permission to the physician or dentist selected by Camp Elienai to hospitalize, to secure proper treatment and/or order an injection, anesthesia, or surgery for me as deemed necessary. I also authorize the first aid attendant on duty at Camp Eleinai to administer medical aid as required for illness or injury under a physician's orders. The signature of the adult below is intended to serve as a medical release. _____________________________________________________________________ Date: _____/_____/_____ Parent or Guardian’s Signature (those 18 years or older may sign for themselves) ______________________________________________________________________________________________ Please PRINT Name Relationship to Camper

Use of Personal Information/Photos: Camp Elienai reserves the right to include picture, videos, or other likenesses of you or your child in its promotional materials.

Check here if you do not want to be included on Camp Elienai’s mailing list.

For Office Use Only: Med Conditions Rx’s/Restrictions Allergies

____________________________________

CAMP ELIENAI

Participation, Release, Waiver & Indemnity Agreement SIGN & RETURN ASAP

I UNDERSTAND THAT WHILE CAMP ELIENAI MAKES EVERY EFFORT TO PROVIDE A SAFE AND PLEASANT ENVIRONMENT FOR ME, I AM REQUIRED TO READ, FILL OUT, SIGN AND DATE THIS PARTICIPATION AGREEMENT FOR MYSELF. I MUST DO THIS IF I WISH TO PARTICIPATE IN THE ACTIVITIES THAT OCCUR AT CAMP ELIENAI. I, the undersigned, will participate in the activities that occur at Camp Elienai, and on or around Camp Elienai. These activities include, but are not limited to, swimming, boating, and competition games. I grant this permission with full knowledge that I accept full responsibility for any injury or accident that may occur. Although Camp Elienai has taken reasonable steps to provide equipment and skilled employees so that I can participate in activities for which I may not be skilled in, these activities are not without risk. Certain risks cannot be eliminated due to the Camp's rural setting and without destroying the unique character of those activities. The same elements that contribute to the character of these activities can be cause of loss or damage to my property, accidental injury or illness or, in extreme cases, permanent trauma or death. I, my assigns and my estate, agree to release and hold harmless Camp Elienai, its owner, officers, Board, agents, or employees, for any and all claims for injuries, causes of action, or liability related to my participation in any activity occurring at Camp Elienai or on or around Camp Elienai. This release does not apply to intentional and/or willful acts of misconduct by Camp Elienai or any of its officers, Board, agents or employees, or other campers. I acknowledge that if this accidental injury occurs, I will be responsible for the medical bills or that I would take advantage of the medical insurance supplied by British American Insurance (read next page) and that I will not hold Camp Elienai responsible. I will be held liable for all legal and medical responsibilities. Should Camp Elienai, or anyone acting on their behalf, be required to incur attorney's fees costs to enforce this agreement, I agree to indemnify and hold Camp Elienai harmless for all such fees and costs. By signing this document, I acknowledge that if anyone is hurt or property damaged during my participation in these activities, I may be found by a court of law to have waived any right to maintain a lawsuit against Camp Elienai on the basis of any claim that has been released herein. I have had sufficient opportunity to read this entire document. I have read and understood it, and agree to be bound by its terms. Print Camper’s Name ______________________________________________________________________ Parent’s Name ____________________________________________________________________________ Parent’s Signature _________________________________________________________________________ Date___________________________________

Camp Elienai • Frazer’s Hog Cay, Bahamas For US residents: 1811 NW 51st St. Ft. Lauderdale, FL 33309. 954.681.4692

For Caribbean residents: P. O. Box N3199. Nassau, Bahamas. 242.436.6128 Box N-3199 * Nassau, Bahamas

1811 NW 51st ST. * # 1165 * Ft. Lauderdale, FL 33309 (954) 681-4692 (U.S.) * 242) 323-6202 (Bahamas)

Fax: (242) 356-3712 (Bahamas) E-mail: evangelistkselver@hotmail.com

2009 DRESS STANDARDS

All campers, counselors, & chaperones should abide by the same dress code.

STANDARDS MALES FEMALES High Enough Shirts that do not expose chest

Pants that do not expose underwear Shirts should reach the clavicle bone

Shirts should not expose cleavage or back No sleeveless shirts Long Enough Activities: Jeans or Shorts

that reach the knees Evening Services: Long Pants

Activities: Knee-length culottes and basketball shorts

Evening Services: Knee-length Skirts Must reach knees while seated

No tops that exposes the midriff when standing or sitting or bending over

Thick Enough No see-through apparel Loose Enough No fitted shirts and/or tight pants Clothes should hang loosly on the body

No fitted blouses, skirts, or culottes Your clothing should not show your shape

We understand that different events call for different apparel. Services and sessions

Guys: Must wear a collared shirt and jeans or khaki pants. Ladies: Must wear a modest blouse and skirt that goes below the knees while seated.

Games and activities Guys: Must wear jeans, sweat pants, or knee length shorts. Ladies: Must wear culottes. (Since it is hard to find culottes, we will allow ladies to wear guy’s basketball shorts. These will be long and lose enough to keep the ladies modest while running and playing. No pants/sweatpants or shorts with wording on the buttocks are permitted

Beach activities Guys: Shorts Ladies: Full bathing suit with a dark colored t-shirt. Shirts and culottes should always be worn over your bathing suit when outside of the waterfront area.

*****The guys and girls will NOT be swimming together. ***** No shirts, hats, pants or other inappropriate clothing with inappropriate messages:

alcohol, tobacco, profanity, sexual references or drugs. When it is raining, campers should refrain from wearing white shirts that could show through.

We really hope you understand the heart behind our standards. If you disagree with these guidelines we suggest you do not come. Also, if a camper disobeys our standards they will not be able to participate in all of the activities and in extreme cases asked to leave the camp. We hope that parents will appreciate the standards God has given us.

CAMP ELIENAI What Do I Bring to Camp?

We are truly excited that you are coming to camp! Now your next question is what do I bring? The first rule of camp is NOT to bring anything expensive or sentimental to you. Jewelry, electronics, or too much money is not allowed. Although the Camp Elienai is a Christian camp, not every one who attends will be a Christian. We would regret if something of value to you was taken or misplaced while at camp. Therefore, if you don’t bring anything like this, it will not be lost. We will not be responsible for stolen items.

Common sense is the best guide for choosing what to bring to camp. There will be mosquitoes and bugs. So make sure you have clothes that can protect you from bites. You will also want to bring clothes that you don’t mind getting dirty. This will be used for fishing and other messy activities.

Because of the size of the transportation we will be using, you can only bring one suitcase. So make it all fit!

TAPE THIS LIST INSIDE YOUR SUITCASE

Required Needs ___ Bible (King James Version) ___ Pen/highlighter ___ Camper Medical Release Form ___ Deodorant ___ Participation, Release, Waiver & Indemnity Agreement ___ Small blanket (girls only) ___ Photo Identification (Bahamian residents) ___ Tennis shoes ___ Official Passport (U.S. residents) ___ Insect repellant ___ Prescription medications ___ Comb, hairbrush ___ Bathing suit ___ Toothbrush/toothpaste ___ Pillow ___ Towels, washcloth ___ Bed Sheets ___ Soap

Optional Needs

(These you can bring but they are NOT required) ___ Sun glasses ___ Disposable Camera ___ Spending Money ___ Hat/Cap (for sun) ___ Personal water container ___ Flashlight/new batteries ___ Snacks (We will have some for purchase) ___ Sun tan lotion ___ Shoes that are waterproof ___ Snorkel and goggles

What NOT to bring

DO NOT BRING ANYTHING SENTIMENTAL OR EXPENSIVE (watches, jewelry, etc.) Electronic devices (mp3’s, cd players, ipods, dvd players, radios, laptop’s, portable video games, cell phones) Questionable Magazines (no nudity or seductive pictures) Illegal Substances (marijuana, cocaine, alcohol, or any questionable substances).

***Anyone who brings anything illegal will be taken to the police.***

Camp Elienai • Frazer’s Hog Cay, Bahamas For US residents: 1811 NW 51st St. Ft. Lauderdale, FL 33309. 954.681.4692 For Caribbean residents: P. O. Box N3199. Nassau, Bahamas. 242.436.6128

This form is for parents/guardians to keep for themselves.

BRITISH AMERICAN INSURANCE COMPANY OF THE BAHAMAS LIMITED

(hereinafter, the Company or British American) In accordance with the premiums, provisions, terms, conditions, limitations and exclusions of this policy herein contained, the

Company agrees with

CONSIDERATION

This policy is issued in consideration of the application of the Policyholder, a copy of which is attached hereto when issued and made

a part hereof, and any individual enrollment forms, if any and of the payment by the Policyholder of premiums as herein provided.

THE PROVISIONS, TERMS AND CONDITIONS contained on the subsequent pages form a part of this contract as fully as if recited at length over the signatures below. The School Accident Plan July 4, 2009 Policy Name: Effective Date: Camp Elienai British American Insurance Co. School Representative

PART 1 DEFINITIONS Wherever used in this policy: “Schedule” means the Schedule of Benefits in the Master Application. “Injury” means accidental bodily injury occurring while coverage is in force as to the insured whose injury is the basis of claim and resulting directly and independently of all other causes in loss covered by this policy. “Principal Sum” means the amount stated in the Schedule as respects to each named insured. “Loss” means, with reference to hand or foot, complete irreparable severance at or above the wrist or ankle: with reference to eye, entire and irrecoverable loss of sight: with reference to speech or hearing, entire and irrecoverable loss of sight; with reference to speech or hearing, entire and irrecoverable loss of either. “Physician” means a person legally licensed to practice medicine and / or surgery other than the injured or a member of the Insured’s immediate family. “Hospital” means an establishment which meets all of the following requirements: a) holds a license as a hospital, if licensing is required in the country or governmental jurisdiction; b) operates primarily for the reception, care and treatment of sick, ailing or injured persons as inpatients; c) provides 24-hour a day nursing service by registered or graduate nurses; d) has a staff of one or more physicians available at all times; e) provides organized facilities for diagnosis and major surgical procedures; f) is not primarily a clinic, nursing, rest or convalescent home or similar establishment and is not, other than incidentally, a place for alcoholics or drug addicts; g) maintains x-ray equipment and operating room facilities. “Permanent Partial Disability” Partial or complete loss of function, especially when involving the motion or sensation in a part of the body. PART - 11 EFFECTIVE DATE, POLICY TERM AND POLICY TERMINATION This policy takes effect and terminates on the dates stated in the Master Policy. All periods of insurance hereunder shall begin and end at 12:01a.m. at the address of the policyholder. PART – 111 AGGREGATE LIMIT OF INDEMNITY The company shall not be liable for any amount in excess of the Aggregate Limit of Indemnity stated in the Schedule as the result of any one accident. If the aggregate amount of all indemnities otherwise payable by reason of coverage provided under this policy exceeds such Aggregate Limit if Indemnity, the maximum indemnity payable to any insured will be a percentage of the indemnity otherwise payable. That percentage will be determined by dividing the Aggregate Limit of Indemnity by the aggregate of all such indemnities. PART IV EXCEPTIONS This policy does not cover any loss or expense caused by or resulting from: 1) Intentionally self-inflicted injury, suicide or any attempt thereat while sane or insane; nor 2) War, invasion, act of foreign enemy, hostilities or warlike operations (whether war be declared or not), mutiny, riot, civil commotion, strike, civil war, rebellion, revolution, insurrections, conspiracy, military or usurped power, martial law, or state of siege; or any of the events or causes which determine the proclamation of or enforcement or martial law or state of siege, seizure, quarantine; or customs regulations; or nationalization by or under the order of any government or public or local authority; or any weapon or instrument employing atomic fission or radioactive force, whether in time of peace or war; nor 3) Any period an insured is serving in the Armed Forces of any country or international authority, whether in peace or war, and in such an event the company, upon written notification by the Policyholder, shall return the pro rata premium for any such period of service; nor 4) Loss sustained or contracted in consequence of an Insured being intoxicated or under the influence of any narcotic unless administered on the advice of a physician; nor 5) Any loss of which a contributing cause was the insured’s attempted commission of, or willful participation in, an illegal act or any violation or attempted violation of the law or resistance to arrest by the Insured; nor 6) Any loss sustained while flying in any aircraft or device for aerial navigation except as specifically provided herein; nor 7) Congenital abnormalities and conditions arising out of or resulting therefore; nor

8) Replacement of eyeglasses, contact lenses or prescriptions except as specifically provided herein; nor 9) Dental treatment except as specifically provided herein; nor 10) Preventive medicines or vaccines. The Insured shall, if so required and as a condition precedent to any liability of the Company, prove that the loss did not in any way arise under or through any of the above excepted circumstances or causes. PART V POLICY PROVISIONS ENTIRE CONTRACT: This policy, including the endorsements and the attached papers, if any, and a copy of the Master Application of the Policyholder constitute the entire contract between the parties and any statement made therein by the Policyholder shall be deemed a representation and not a warrant. No such statement shall avoid the insurance or reduce the benefits under this policy or be used in defense of a claim hereunder unless it is contained in a written application signed by the Policyholder. No change in this policy shall be valid unless approved by an executive officer of the Company and unless such approval be endorsed hereon or attached hereto. No agent has authority to change this policy or to waive any of the policy provisions. NOTICE OF CLAIM: Written notice of claim must be given to the Company within thirty (30) days after the occurrence or commencement of any loss covered by this policy, or as soon thereafter as is reasonably possible. Notice given by or on behalf of the Insured to the Company, with information sufficient to identify the Insured shall be deemed notice to the Company. CLAIM FORMS: The Company, upon receipt of a written notice of claim, will furnish to the claimant such forms as are usually required by the Company for filing proofs of loss. Is such forms are not furnished within (15) days after the giving of such notice, the claimant shall be deemed to have complied with the requirements of this policy as to providing proof of loss upon submitting, within the time fixed in the policy proofs, written proof covering the occurrence the character and the extent of the loss for which claim is made. TIME FOR FILING PROOF OF LOSS: Written proof of loss must be furnished to the Company within ninety (90) days after the date of such loss. Failure to furnish such proof within the time required shall not invalidate nor reduce any claim if it is furnished as soon as reasonably possible. TIME OF PAYMENT OF CLAIMS: Indemnities payable under this policy will be paid immediately upon due written proof of such loss. PAYMENT OF CLAIMS: Indemnity for loss of life will be payable in accordance with the beneficiary designation and the provisions respecting such payment prescribed herein and effective at the time of payment. If no such designation or provision is then effective, such indemnity shall be payable to the estate of the Insured. Any other accrued indemnities unpaid at the Insured’s death may, at the option of the Company, be paid either to such beneficiary or to such estate. All other indemnities will be payable to the Insured. All such payments are subject to the Laws of the Bahamas as applicable to this plan. TO WHOM INDEMNITIES ARE PAYABLE: If any indemnity of this policy shall be payable to the estate of the Insured or to an Insured who is a minor or otherwise not competent to give a valid release, the Company may pay such indemnity to the Insured’s parent, guardian or other person actually supporting the Insured. Any payment made by the Company in good faith pursuant to this shall fully discharge the Company to the extent of such payment. Subject to any written direction of the insured or if the legal or natural guardian of the Insured if the Insured is a minor or otherwise incompetent to make such a direction, all or a portion of any indemnities provided by this policy as a result of medical, surgical, dental, hospital or nursing service may, at the Company’s option, and unless the Company is required otherwise in writing not later than the time of filing proofs of loss, be paid directly to the hospital or person rendering such service; but is not required that the service be rendered by a particular hospital or person. CONSENT OF THE BENEFICIARY: Consent of the Beneficiary shall not be requisite for change of Beneficiary or any other changes in this policy. PHYSICAL EXAMINATION AND AUTOPSY: The Company, at its own expense, shall have the right and opportunity to examine any insured whose injury or sickness is the basis of claim when and as often as the Company may reasonably be required during the pendency of a claim hereunder and to make an autopsy in case of death, where it is not forbidden by law. LEGAL ACTION: No action at law or in equity shall be brought to recover on this policy prior to the expiration of sixty (60) days after written proof of loss has been furnished in accordance with the requirements of this policy. No such action shall be brought after the expiration of three (3) years after the time written proof of loss is required to be furnished.

DESIGNATION OR CHANGE OF BENEFICIARY: The right to change of beneficiary is reserved to the Insured. No change of beneficiary under this policy shall be binding upon the Company until the Original or a duplicate thereof is received by the Company. The Company assumes no responsibility for the validity of such change. CANCELLATION: The Company may cancel this policy at any time by written notice delivered to the Policyholder or mailed to the last address as shown by the records of the Company stating when, not less than 30 days thereafter such cancellation shall be effective. In the event of such cancellation, the Company will return promptly the pro rata unearned portion of any premium paid by the Policyholder. Such cancellation shall be without prejudice to any claim originating prior thereto. CONFORMITY WITH STATUTES: Any provision of this policy which, on its effective date, is in conflict with the statutes of the jurisdiction in which this policy was delivered is hereby amended to confirm to the minimum requirement of such statutes. ADDITIONAL PROVISIONS The Insurance of any Insured shall not be prejudiced by the failure on the part of the Policyholder to transmit reports, pay premium or comply with any of the provisions of this policy when failure is due to inadvertent error or clerical mistake. All books and records of the Policyholder containing information pertinent to this insurance shall be open to examination by the company during the policy term and within one year after the termination of this Policy. BENEFITS Option A Accidental Medical Expense Benefit:* $7,500 (This is the amount given if your child is injured at camp) Accidental Death Benefit $5,000 Permanent Partial Disability Benefit $15,000 Annual Deductible $25 Dental Expense Limit $750 Loss of both hands or both feet $15,000 Loss of sight in both eyes $15,000 Loss of hearing or speech $15,000 Loss of sight in one eye $7,500 Loss of either one hand or one foot $7,500 Loss of thumb and index finger $3,750 In order for the Accidental Death Benefit to be payable, loss of life from a specific accidental means must occur within 180 days of that accident. Accidental dismemberment means actual severance and must be fully irreversible. If injury does not result in loss of life within 180 days, the Company will pay the appropriate and relevant dismemberment benefits shown. PERMANENT PARTIAL DISABILITY (Statement of Proof from Physician Required) Waiting Period - 60 days AGGREGATE LIMIT OF LIABILITY $60,000

British American Insurance Company Of the Bahamas Ltd. Independence Drive

Nassau, Bahamas Phone: 242-461-1000

Fax: 242-361-2524 Email: babexec@bahamas.net.bs