THIS PAGE MUST BE SIGNED & MAILED TO THE REGISTRAR IN ORDER FOR ONLINE REGISTRATION TO BE COMPLETED. CAMP CONFIRMATION CARD WILL NOT BE SENT UNTIL THIS SIGNED WAIVER IS RECEIVED.
PLEASE MAIL TO: Registrar – Aldersgate Camp & Retreat Center – 125 Aldersgate Camp Rd. – Ravenna, KY | 40472
In signing this application I give permission and consent for my child to participate in any and all camp activities including, without limitations, the swimming pool, creek, hiking, horseback riding, caving, games, the zip line, ropes course, rock climbing, rappelling, etc., and off-site activities, including transportation to and from, (except as noted above). I certify that my child is in good physical condition for all camp activities.
I understand that the nature of outdoor camping ministries includes some risk of injury or death. I realize that campers can become ill and need medical attention. I hereby give permission to the camp Health Care Provider to give over the counter medication (such as Advil, etc.) to my child as proper treatment as deemed necessary for minor ailments. In case of Emergency, I hereby give permission to the physician, nurse, hospital, etc. selected by the Camp Director (or his representative) to hospitalize, secure proper treatment for, and to order injection, anesthesia or surgery for my child, as named above. In case of illness or accident I give permission for the release of medical records for medical and insurance purposes. I hereby release Aldersgate from responsibility for injury to my child. I agree to submit my insurance claims to my insurance carrier first and will only use Aldersgate’s insurance plan as a secondary insurance.
I give permission for the use of photographs or videos including my child in camp publicity and promotion and for the distribution of my child’s mailing address out to campmates. This completed form may be copied for transportation record.
Print Camper’s name:___________________________________________________________
Camp Registering for:___________________________________________________________
Camper’s Signature____________________________________________Date: ___________
Parent/Guardian’s Signature_____________________________________________________Date:____________
Mail completed form to: Aldersgate Camp, Attention: Registrar, 125 Aldersgate Camp Rd, Ravenna, KY 40472
[IMPORTANT NOTE: If online registration says "Camp Full" online registration is closed, HOWEVER, please call (606)723-5078 for availability. There may be space available for mail in registration.]
Don’t want to use a credit card? Want to sign up the old-fashioned way? Sending partial payment?
Then click here to download a registration form:
