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HSM Snow Camp Leader Registration 2022 on Friday, February 11, 2022 @ 4:00 PM

30.00
The cost of Snow Camp for leaders is $30. If you are in need of a scholarship please contact us at HSM@blackhawkchurch.org BEFORE continuing on this form. (This will not take away from a students ability to participate, so please don't hesitate to reach out if needed)
*Community Group:
AASM:
COVID-19 Mitigation policies: In order to attend camp, students and adults must be vaccinated for COVID-19 or have a negative COVID-19 test within 48hrs of the start of camp. Due to the length of time we will be away and distance of travel it is important for contact tracing to know who is vaccinated/unvaccinated. Vaccination status will not be shared outside of our staff team and will only be used as needed for contact tracing and quarantining while at camp if someone begins showing symptoms of COVID-19 and/or tests positive. Read more detail about our camp COVID policies here.
*COVID-19 Vaccination Status (at the time of camp):
*In the event that a leader begins feeling ill during camp, we will ask for that leader to take a rapid COVID-19 test (provided) for contact tracing purposes. Additionally, we ask that leaders identify someone who would be willing/able to pick you up from camp in the event that you become ill (please identify that person here). If you do not have someone who is able to do this please indicate that and we will work with you to find a solution:
Though we are doing everything that we can to prevent someone from arriving to camp with COVID-19 or any illness, we recognize in this unique season that we need to be prepared to respond in the event that a student or leader becomes ill. In order to do that well, we need to assemble a group of 4-6 leaders who plan to be at camp who would be willing to be on a "COVID response team." Some of the things we may need include:
- Stay in adjoining cabin or inn room with sick student (not in the same room), while we wait for parents to come pick them up
- Speak with sick student to understand symptoms & administer COVID-19 nasal swab
- Take symptoms/information and in partnership with staff make decisions on when and how to get the student home
- Willing to stay up to 4 hours late on Sunday to wait for parent OR potentially drive sick student back to Madison in a provided rental vehicle (if someone becomes ill on Sunday morning right before busses leave).
**We recognize there are varying levels of comfort that one may feel with the different things listed above, if you'd like to join the team please respond below with your level of comfort.
*Willing to be on the COVID response team?
For those who answered yes: Is there anything you'd like us to know related to your level of comfort with the varying 'sick person' response jobs listed above?
*T-shirt size:
Food allergies / Dietary Restrictions?:
*Insurance Company:
*Group & account number:
Emergency Contact:
*Name:
*Phone Number:
*Relationship to you:

RELEASE & WAIVER OF LIABILITY, ASSUMPTION OF RISK & INDEMNITY AGREEMENT

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The following is a liability waiver. By signing the waiver, you are waiving your right to sue or otherwise claim that Blackhawk Church is liable for any injuries or other damages you might suffer during this event/activity that are a result of an accident or your own negligence. The waiver does not release Blackhawk Church from potential liability for injuries or other damages resulting from Blackhawk Church's intentional or reckless acts. Please read the waiver carefully before signing.
IN CONSIDERATION of access to and participation in Snow Camp hosted by Blackhawk Evangelical Free Church (the “Host”), at Forest Springs, on February 11-13, 2022 EACH OF THE UNDERSIGNED, for himself/herself, his or her personal representatives, heirs, and next of kin::
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1. HEREBY WARRANTS AND REPRESENTS that: (i) he or she understands that the particular event/activities which he or she may participate in involve [transportation, vigorous physical exercise, including by way of example running, cold temperatures, sports activities, and prolonged or peak physical activity], (the “Event/Activities”); (ii) he or she understands that there are significant risks associated with participation in the Event and the Activities, including by way of example the possibility of serious injury or death caused by [transportation, falling, exertion, or physical activity]; (iii) he or she understands that the Event/Activities may or may not be supervised by the Host’s employees or agents; (iv) he or she understands that emergency care may not be immediately available in the event of an injury or health event during the Event/Activities; and (v) he or she is in sufficient physical condition and is physically able to undertake all Activities related to the Event; has no disability, impairment or ailment preventing him or her from active or passive exercise, or that will be detrimental to his or her health, safety, comfort or condition if he or she does so engage or participate.:
*Participant initials, 1:
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2. HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE the Host or its Elders, staff, sponsors, directors, officers, agents and employees, all for the purposes herein referred to as “Releasees,” FROM ALL LIABILITY, TO THE UNDERSIGNED, his or her personal representatives, assigns, heirs, and next of kin FOR ANY AND ALL LOSS OR DAMAGE, AND ANY CLAIM OR DEMANDS THEREFOR ON ACCOUNT OF INJURY TO THE PERSON OR PROPERTY OR RESULTING IN DEATH OF THE UNDERSIGNED ARISING OUT OF OR RELATED TO THE EVENT/ACTIVITIES, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE (BUT NOT INCLUDING INTENTIONAL OR RECKLESS ACTS OF THE RELEASEES).:
*Participant initials, 2:
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3. HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the Releasees and each of them FROM ANY LOSS, LIABILITY, DAMAGE, OR COST he or she may incur arising out of or related to THE EVENT/ACTIVITIES WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE (BUT NOT INCLUDING INTENTIONAL OR RECKLESS ACTS OF THE RELEASEES).:
*Participant initials, 3:
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4. HEREBY ACCEPTS THE RISK AND ASSUMES FULL RESPONSIBILITY FOR ANY RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE arising out of or related to THE EVENT/ACTIVITIES whether caused by the NEGLIGENCE OF RELEASEES or otherwise (BUT NOT INCLUDING INTENTIONAL OR RECKLESS ACTS OF THE RELEASEES), and furthermore acknowledges, pursuant to the recreational activities statute, Wis. Stat. § 895.525, that he or she has a responsibility to act within the limits of his or her ability, to heed all warnings regarding participation in the recreational activity, to maintain control of his or her person and any applicable equipment or devices, and to refrain from acting in any manner that may cause or contribute to death or injury for himself or herself or to other persons.:
*Participant initials, 4:
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5. HEREBY acknowledges that prior to signing this Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement, he or she had the opportunity to contact a representative of the Host to discuss and/or bargain regarding any of the terms set forth herein.:
*Participant initials, 5:
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I HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.:
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*Participant signature:
typing your name serves as your signature:
Promo code section is to be used for scholarships. If you are in need of a scholarship please email us at HSM@blackhawkchurch.org BEFORE submitting this form.