CrossTimbers 2024 Camper Release Form Camper InformationRegistration Type(Required) Child Adult An Adult is anyone that will be 18 years old at the time of camp.Name(Required) First Last Date of Birth(Required) MM slash DD slash YYYY Grade Completed(Required) 3rd Grade 4th Grade 5th Grade 6th Grade Gender(Required)Please SelectMaleFemaleShirt Size(Required)Please SelectYouth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult X LargeAdult 2X LargeAdult 3X LargeAdult 4X LargeAdult 5X LargeChurch InformationChurch Attending Camp With (Affiliated)(Required)Please Select-OtherAltus, Martha RoadArdmore, FirstAtoka, HarmonyBeggs, CrossroadsBethany, Council RoadBethel Acres, New HopeBlackwell, ImmanuelBlanchard, FirstBroken Arrow, Arrow HeightsBroken Arrow, Aspen ParkByarsChandler, FirstChecotah, FirstChickasha, FirstChoctaw, FirstCrescent, FirstCushing, FirstCushing, Oak GroveDavis, ImmanuelDel City, First SouthernDuncan, FirstDuncan, Freedom BikerDuncan, New Hope WestEdmond, FirstEdmond, North PointeEdmond, OakdaleEdmond, Waterloo RoadEl Reno, FirstElgin, CrossroadsElk City, OneElmore City, FirstEnid, EmmanuelEufaula, FirstFletcher, FirstGoldsbyHarrah, FirstHennepin, FirstHennessey, FirstHinton, FirstHobart, FirstLaverne, FirstLawton, CentralLawton, FirstLawton, First EastLawton, First WestLawton, ImmanuelLindsay, CalvaryLindsay, Erin SpringsLindsay, FirstMarlow, FirstMaud, TrinityMcAlester, FirstMoore, FirstMoore, Regency ParkMuskogee, New CommunityMuskogee, SoutheastMuskogee, TimothyMustang, Chisholm HeightsMustang, FirstMustang, Mustang HeightsMWC, FirstMWC, MeadowoodNewcastle, FirstNewcastle, Woodland HillsNicoma Park, FirstNoble, FirstNorman, BethelNorman, FranklinNorman, New Life BibleNorman, NortheastNorman, TrinityOchelata, FirstOKC, BrookwoodOKC, Capitol HillOKC, Cherokee HillsOKC, Eagle HeightsOKC, Exchange AvenueOKC, Grace PlaceOKC, NorthwestOKC, Putnam CityOKC, Quail SpringsOKC, South LakesOKC, South LindsayOKC, Southern HillsOKC, SouthparkOKC, SpringdaleOKC, Together ChurchOKC, TrinityOKC, VillageOkemah, FirstOkmulgee, ClearViewOlive, FirstOwasso, CentralOwasso, The RefugePauls Valley, BeatyPerkins, FirstPiedmont, FirstPonca City, FirstPonca City, NortheastPoteau, Cross CommunityPrague, FirstPurcell, EmmanuelPurcell, FirstPurcell, Union HillQuinton, West LibertyRush Springs, Vimy RidgeSand Springs, Church That MattersSasakwa, FirstSeminole, FirstShawnee, Blackburn ChapelShawnee, Heritage First ChurchShawnee, ImmanuelShawnee, Rock CreekShawnee, UniversityStillwater, Eagle HeightsStillwater, University HeightsStroud, FirstTishomingo, CalvaryTulsa, Iglesia Biblica BautistaTulsa, OlivetTulsa, Southern HillsTuttle, Snow HillWagoner, FirstWebbers Falls, FirstWhitesboroYukon, Canadian ValleyYukon, FirstYukon, Surrey HillsSelect the church you are coming to camp with. If your church is a not listed in this list please select "-Other" and another field will appear below.Church Attending Camp With (Non-Affiliated)(Required)Please SelectPlano Willow BendFort Gibson Fellowship BiblePlano, TX Willow Bend ChurchPlano Willow Bend ChurchEl Reno Heaston CommunityYukon Covenant CommunityJenks Jenks ChurchMulvane FirstCamp PastorParis FirstEdom FirstSelect the church you are coming to camp with. If your church is a not listed in either of these drop-downs please contact the Childhood Ministry office at 405-942-3800.Contact InformationParent/Guardian Name(Required) First Last Phone(Required)Email Address(Required) Address(Required) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Emergency ContactEmergency Contact Name(Required) Relationship(Required) Phone(Required)Medical InformationDoes the camper have ANY known allergies?(Required) Yes No Please specify allergies(Required) Does the camper take any medications regularly?(Required) Yes No Please list medications and what they are taken for(Required) Example: Claritin - Seasonal allergiesPlease list any other medical condition(s) or dietary restrictions that would be helpful to know. Date of last tetanus immunization(Required) Insurance InformationInsurance Company(Required) Insurance Phone(Required)Name on Insurance Policy(Required) Policy Number(Required) Mailing Address for Medical Claims(Required) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Does your insurance company require notification prior to emergency health care at a hospital?(Required) Yes No Phone Number for Notification(Required)Attending ParentWill a parent or guardian of camper the be attending camp as well?(Required) Yes No Name of Attending Parent/Guardian(Required) First Last Release & Waiver of ClaimsChild Camper Consent(Required) I AgreeI understand that it is the responsibility of my child’s Host Church to obtain insurance permission for treatment or to limit my child’s recreational activities because of a stated medical condition. My child will be attending Cross Timbers during the summer session. CrossTimbers Children’s Missions Adventure Camp is managed and operated by the Baptist General Convention of Oklahoma (“OKLAHOMA BAPTISTS”). In the event that my child should need emergency medical care or attention, the Host Church leadership, OKLAHOMA BAPTISTS or any of their agents or employees is hereby authorized to consent to the provision of such emergency medical care, including without limitation, medical, dental, surgical care or hospitalization, to my child as is recommended or suggested by a physician, nurse, surgeon or other health care professional. If such emergency care is provided, I understand that my health insurance information will be given to the health care professional and that any expenses not covered by my insurance shall be my responsibility. I understand that the Host Church or the OKLAHOMA BAPTISTS will not be obligated to pay either the health care professional or me for any medical expenses incurred. There are instances when third party contractors are used to operate and supervise various events and activities. In those instances where third party contractors are used, I agree that neither the Host Church nor the OKLAHOMA BAPTISTS is responsible for the action of these third party contractors. I further agree that neither the Host Church nor the OKLAHOMA BAPTISTS is liable for the actions or activities of participants or sponsors participating in events or activities operated by third party contractors. I understand that the risk of injury from any recreational activity is significant, including, but not limited to, the potential for permanent paralysis and death. While particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist. I knowingly and freely assume all risks, both known and unknown, even if arising from negligence, and assume full responsibility for my child’s participation in or observation of such recreational activity. Furthermore, in consideration of my child being allowed to attend CrossTimbers, I, on behalf of myself and my child, hereby waive, and I hereby agree to indemnify and hold harmless the Host Church, the OKLAHOMA BAPTISTS, their agents or employees, against any and all causes of action, rights, claims or suits which I or my child may have against the Host Church, the OKLAHOMA BAPTISTS, or their agents or employees as a result of injury to my child, including, but not limited to: (1) injuries arising from my child’s participation in or observation of recreational activities at CrossTimbers, and (2) injuries arising from the decision of the leadership of the Host Church, the OKLAHOMA BAPTISTS, or any of their agents or employees to consent to the provision of emergency medical care to my child. I understand that my child’s image may be included in a video or in photographs that may be made during camp. I consent that my child’s image may appear on videos, promotional resources, camp endorsed web sites, etc. I give authority and permission to the Host Church, the OKLAHOMA BAPTISTS, and any of their staff or agents to inspect my child’s belongings while at CrossTimbers. I understand that CrossTimbers is a place where many students seek counsel and advice from adult leaders, staff, counselors, and others. I hereby consent to my child receiving spiritual and emotional counsel during their week of camp. Adult Camper Consent(Required) I AgreeI understand that it is my responsibility to obtain insurance permission for treatment. I will be attending CrossTimbers during the summer session. CrossTimbers Missions Adventure Camp is managed and operated by the Baptist General Convention of Oklahoma (“Oklahoma Baptists”). In the event that I should need emergency medical care or attention, the Host Church leadership, the OKLAHOMA BAPTISTS or any of their agents or employees is hereby authorized to consent to the provision of such emergency medical care, including without limitation, medical, dental, surgical care or hospitalization, to me as is recommended or suggested by a physician, nurse, surgeon or other health care professional. If such emergency care is provided, I understand that my health insurance information will be given to the health care professional and that any expenses not covered by my insurance shall be my responsibility. I understand that the Host Church or the OKLAHOMA BAPTISTS will not be obligated to pay either the health care professional or me for any medical expenses incurred. There are instances when third party contractors are used to operate and supervise various events and activities. In those instances where third party contractors are used, I agree that neither the Host Church nor the OKLAHOMA BAPTISTS is responsible for the action of these third party contractors. I further agree that neither the Host Church nor the OKLAHOMA BAPTISTS is liable for the actions or activities of participants or sponsors participating in events or activities operated by third party contractors. I understand that the risk of injury from any recreational activity is significant, including, but not limited to, the potential for permanent paralysis and death. While particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist. I knowingly and freely assume all risks, both known and unknown, even if arising from negligence, and assume full responsibility for my participation in or observation of such recreational activity. Furthermore, in consideration of being allowed to attend CrossTimbers, I hereby waive, and I hereby agree to indemnify and hold harmless the Host Church, the OKLAHOMA BAPTISTS, their agents or employees, against any and all causes of action, rights, claims or suits which I may have against the Host Church, the OKLAHOMA BAPTISTS, or their agents or employees as a result of injury to me, including, but not limited to: (1) injuries arising from participation in or observation of recreational activities at CrossTimbers, and (2) injuries arising from the decision of the leadership of the Host Church, the OKLAHOMA BAPTISTS, or any of their agents or employees to consent to the provision of emergency medical care to me. I understand that my image may be included in a video or in photographs that may be made during camp. I consent that my image may appear on videos, promotional resources, camp endorsed web sites, etc. I give authority and permission to the Host Church, the OKLAHOMA BAPTISTS, and any of their staff or agents to inspect my belongings while at CrossTimbers.Signature(Required)Relationship to child(Required)
