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Sylvan Lake Lutheran Bible Camp Association
Group Name
Program Dates
Contact Name
Grade(s)
SCHOOL INFORMATION Please send this form to camp AT LEAST ONE WEEK prior to your arrival at Kuriakos Outdoor School.
NUMBER OF STUDENTS ATTENDING
Males
Females Total
TEACHERS AND VOLUNTEERS ATTENDING
Adults Attending
Role
Dietary restrictions Class Name (teachers)
eg. 4A 1.
2.
3.
4.
5.
6.
7.
8.
9.
Sylvan Lake Lutheran Bible Camp Association
Group Name
Program Dates
Contact Name
Group # Total # of Grps
STUDENT GROUPING Please send this form to camp AT LEAST ONE WEEK prior to your arrival at Kuriakos Outdoor School.
Student Name Class
Birth date if during Outdoor School
Dietary restrictions and learning, emotional or health concerns and conditions
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
For KOS use only
COUNSELLOR: ____________________ SCHEDULE: _____________________
CAMP KURIAKOS
MEDICAL INFORMATION – WAIVER FORM This form is collected from participants under 18 years age, participating in Camp Kuriakos programming. Programming
may include, but is not limited to, high ropes challenge course, low ropes challenge course, climbing tower, bouldering wall, archery, games, initiative activities, fire building, outdoor cooking, swimming, canoeing, kayaking, wind surfing, sports, wood working, craft projects. All information will be kept private, used only in accordance with the Privacy Policy of Camp Kuriakos. Name:___________________________________________ Program Date(s):_____________________________ Program Name: ____________________________________________________________________________________ Name of my group:_______________________________________________________________________ Name of my group leader: _________________________________________________________________ MEDICAL / EMERGENCY INFORMATION AB Health Care #:__________________________________________________________ Please list any medical conditions, allergies, or prescriptions which Camp Staff / emergency medical personal should be aware of? ___________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ In case of emergency, please notify: #1. Name:__________________________________ Relationship:____________________ Phone:_________________ #2. Name:__________________________________ Relationship:____________________ Phone:_________________ To the best of my knowledge, the above information is accurate and complete. ____________________________ ___________________________________________________________ (date) signature of parent / guardian WAIVER / CONSENT FORM
Camp Kuriakos Site 8 Box 18 RR1 Sylvan Lake, AB T4S 1X6 403.746.2702 www.kuriakos.ab.ca
I, ______________________________ ,(print name of parent/guardian) on behalf of _________________________________, (print name of camper ), hereby release CAMP KURIAKOS (Sylvan Lake Lutheran Bible Camp Association), its agents, members, and employees and hold them harmless from any and all liability for any accident, injury or any claim arising out of this camper’s use of CAMP KURIAKOS or any of its facilities, or by virtue of participation in any of its programs. I am aware of the risks involved in participation. I understand that Camp Kuriakos has the right to dismiss any camper, if behaviour causes hazard to the staff, the facility, or other participants, without refund. In case of emergency, in the event that I am unable to consent, I hereby authorize the Executive Director and/or Camp Staff to secure medical advice and services as may be deemed necessary for this camper’s health and safety, including ordering injection, anaesthesia or surgery. I accept financial responsibility for any additional expense that may result from such services. I also consent to the use of any photograph, video, or other image taken of this camper while at Camp Kuriakos for the purpose of promoting Camp Kuriakos. _____________________ __________________________________________________ (date) (signature of parent / guardian)
CAMP KURIAKOS
MEDICAL INFORMATION – WAIVER FORM This form is collected from legal adults participating in Camp Kuriakos programming. All information will be kept private,
used only in accordance with the Privacy Policy of Camp Kuriakos. Name:___________________________________________ Program Date(s):_____________________________ Program Name: ____________________________________________________________________________________ Name of my group (if applicable):_______________________________________________________________________ Name of my group leader (if applicable): _________________________________________________________________ MEDICAL / EMERGENCY INFORMATION AB Health Care #:__________________________________________________________ Please list any medical conditions, allergies, or prescriptions which Camp Staff / emergency medical personal should be aware of? ___________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ In case of emergency, please notify: Name:____________________________________ Relationship:____________________ Phone:_________________ To the best of my knowledge, the above information is accurate and complete. ____________________________ ___________________________________________________________ (date) signature of adult camper WAIVER / CONSENT FORM
Camp Kuriakos SITE 18 BOX 8 RR1 Sylvan Lake, AB T4S 1X6 403-746-2702 www.kuriakos.ab.ca
I, ______________________________ (print name of adult camper who will sign this waiver), hereby release CAMP KURIAKOS (Sylvan Lake Lutheran Bible Camp Association), its agents, members, and employees and hold them harmless from any and all liability for any accident, injury or any claim arising out of my use of CAMP KURIAKOS or any of its facilities, or by virtue of participation in any of its programs. I am aware of the risks involved in my participation. I understand that Camp Kuriakos has the right to dismiss me if my behaviour causes hazard to the staff, the facility, or other participants, without refund to me. In case of emergency, in the event that I am unable to consent, I hereby authorize the Executive Director and/or Camp Staff to secure medical advice and services as may be deemed necessary for my health and safety, including ordering injection, anaesthesia or surgery. I accept financial responsibility for any additional expense that may result from such services. I also consent to the use of any photograph, video, or other image taken of myself while at Camp Kuriakos for the purpose of promoting Camp Kuriakos. ___________________ ______________________________________________ (date) (signature of adult camper)
Get ready for KOS! You have the chance to spend a few days at Kuriakos Outdoor School on
Sylvan Lake. The list below is provided to help you make sure you are
ready to take advantage of this special opportunity.
Kuriakos has heated facilities, but you will be spending a lot of time
outside. Please make sure you have warm clothes, rain proof clothes, and
proper foot wear for enjoying all kinds of weather outside.
Get ready for KOS! You have the chance to spend a few days at Kuriakos Outdoor School on
Sylvan Lake. The list below is provided to help you make sure you are
ready to take advantage of this special opportunity.
Kuriakos has heated facilities, but you will be spending a lot of time
outside. Please make sure you have warm clothes, rain proof clothes, and
proper foot wear for enjoying all kinds of weather outside.
• Closed toed shoes with laces. Running shoes work best. If it’s snowy, winter boots are essential. No sandals,
crocs, or flip flops may be worn on the challenge course or during active games.
• Comfortable clothes that stretch easily to allow for free movement during activities. All shorts must come to
the knees. All shirts must cover the torso. It is best to dress in layers, as temperatures vary throughout the day.
Athletic wear works the best for all activities.
• Water proof coat • Warm jacket • Waterproof footwear • Day pack
• Sleeping bag + pillow •Bathing suit and towel for lake/sauna • Water Bottle
• Toiletries: toothbrush, toothpaste, soap, deodorant, sunscreen, bug spray, shampoo, conditioner
You DO NOT need cell phones, ipods, ipads, iphones, video games, or knives of any kind.
www.kuriakos.ab.ca
• Closed toed shoes with laces. Running shoes work best. If it’s snowy, winter boots are essential. No sandals,
crocs, or flip flops may be worn on the challenge course or during active games.
• Comfortable clothes that stretch easily to allow for free movement during activities. All shorts must come to
the knees. All shirts must cover the torso. It is best to dress in layers, as temperatures vary throughout the day.
Athletic wear works the best for all activities.
• Water proof coat • Warm jacket • Waterproof Footwear • Day pack
• Sleeping bag + pillow •Bathing suit and towel for lake/sauna • Water Bottle
• Toiletries: toothbrush, toothpaste, soap, deodorant, sunscreen, bug spray, shampoo, conditioner
You DO NOT need cell phones, ipods, ipads, iphones, video games, or knives of any kind.
www.kuriakos.ab.ca
Getting to Camp Kuriakos
Approximate Driving Times to Kuriakos From Red Deer: 35 minutes From Sylvan Lake: 20 minutes From Edmonton or Calgary: 2 hours Camp Mailing Address: Box 372 Bentley, AB T0C 0J0 Camp email: [email protected] Website: www.kuriakos.ab.ca *please address all inquiries regarding Confirmation Retreats to Laureen Wray
Contacting Camp Kuriakos Staff Day of Programming, call the Camp Phone: 403-746-2702
Assistant Director: Paul Kopjar [email protected]
Executive Director: Laureen Wray
Camp Mailing address: Site 8, Box 18, RR #1, Sylvan Lake, AB T4S 1X6 Camp Email: [email protected] Camp Website: www.kuriakos.ab.ca How can people at home reach you at camp?
We suggest that one adult leader from your group is responsible for having a cell phone, which people who need to reach you may use. People may contact the camp phone, however the camp phone will not be monitored for 2-3 hours at a time while staff are providing programming.
