Basic Info

Full Name *

Email Address *

Age *

Date of Birth *

Describe your relationship with Jesus Christ *

Why do you want to be on staff with Camp HOPE? *

Do you have any dietary restrictions? If yes, please elaborate

Have you ever been convicted of, or pleaded guilty to, a crime? *

Reference 1

Full Name *

Relationship *

Email Address *

Primary phone *

Reference 2

Full Name

Relationship

Email Address

Primary Phone

Reference 3

Full Name

Relationship

Email Address

Primary Phone

Medical Info

Emergency Contact Name *

Relationship *

Phone Number *

Emergency Contact Name *

Relationship *

Phone Number *

Medications *

Allergies *

Conditions *

I understand that I will be in the care of HOPE in Alaska Ministries during the mission trip.

In case of Emergency, I hereby give HOPE in Alaska Ministries (Alaska Outreach, the local church, HOPE in Alaska Ministry Inc, and the Alaska Ministry Network) the permission to act on my behalf in seeking emergency treatment for me in the event that such treatment is deemed necessary by HOPE in Alaska Ministry. I hereby give permission to the medical personnel selected by HOPE in Alaska Ministry to order x-rays, routine tests, treatment; to maintain and/or release any medical records deemed necessary for insurance purposes. I absolve HOPE in Alaska Ministry (this includes Alaska Outreach, the local church, HOPE in Alaska Ministry Inc, and the Alaska Ministry Network) from liability in acting on my behalf in this regard.

I agree to the medical conditions. *

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Date *

In exchange for participation in the activity of Summer Camp organized by HOPE in Alaska Ministry (“Camp HOPE”), of PO Box 2967, Bethel, AK 99559 and/or use of the property, facilities and services of Camp HOPE, I agree for myself and (if applicable) for the members of my family, to the following:

1) I agree to observe and obey all posted rules and warnings, and further agree to follow any oral instructions or directions given by Camp HOPE, or the employees, representatives or agents of Camp HOPE.

2) I recognize that there are certain inherent risks associated with the above described activity and I assume full responsibility for personal injury to myself and (if applicable) my family members, and further release and discharge Camp HOPE for injury, loss or damage arising out of my or my family’s use of or presence upon the facilities of Camp HOPE, whether caused by the fault of myself, my family, Camp HOPE or other third parties.

3) I agree to indemnify and defend Camp HOPE against all claims, causes of action, damages, judgments, costs or expenses, including attorney fees and other litigation costs, which may in any way arise from my or my family’s use of or presence upon the facilities of Camp HOPE.

4) I agree to pay for all damages to the facilities of Camp HOPE caused by my or my family’s negligent, reckless, or willful actions.

5) Any legal or equitable claim that may arise from participation in the above shall be resolved under Alaska law.

6) I give permission for hospital or clinic staff to administer necessary treatment immediately to my child should he/she be sick or injured while participating in Camp HOPE.

7) To promote, evaluate, or otherwise describe the HOPE in Alaska Ministry programs and activities, I give permission to the HOPE in Alaska Ministry, and its agents to use in connection with any publication any image or recording in which I or my child appear, to use and cite any comment(s), verbal or written, made about the program, and to use my name in connection with any publication and in such manner as determined by HOPE in Alaska Ministry. I have read this document and understand it. I further understand that by signing this release, I voluntarily surrender certain legal rights.

I agree to the above conditions. *

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Date *

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