Health Information & Medical Release
I certify that the health history provided on this form is true and correct to the best of my knowledge. In case of an emergency involving my child, I understand that efforts will be made to contact the individual listed as the emergency contact person by the medical provider and/or adult leader. Permission is hereby given to the medical provider selected by the adult leader in charge to secure proper treatment, including hospitalization, anesthesia, surgery, or injections of medication for my child. Medical providers are authorized to disclose protected health information to the adult in charge, camp medical staff, camp management, and/or any physician or health-care provider involved in providing medical care to the participant. Protected Health Information/Confidential Health Information (PHI/CHI) under the Standards for Privacy of Individually Identifiable Health Information, 45 C.F.R. §§160.103, 164.501, etc. seq., as amended from time to time, includes examination findings, test results, and treatment provided for purposes of medical evaluation of the participant, follow-up and communication with the participant’s parents or guardian, and/or determination of the participant’s ability to continue in the program activities.
CONSENT
Consent is expressly given, in the event of injury, for any emergency aid, anesthesia, and/or operation, if in the opinion of the attending physician, such treatment is necessary.
TIFIE RANCH
Waiver of Liability and Hold Harmless Agreement
I am in good physical condition and fully able to participate in the activities at Tifie Ranch. I am fully aware of the risks and hazards connected with participation, including physical injury or even death, and herby elect to voluntarily participate in the activities, knowing that it may be hazardous to me and my property. I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISKS OR LOSS, PROPERTY DAMAGE, OR PERSONAL INJURY, INCLUDING DEATH, that may be sustained by me, or loss or damage to property owned by me, as a result of participation in Tifie Ranch activities.
I hereby RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE, Tifie Ranch, its owners, affiliates, agents, employees and/or assigns (hereinafter referred to as RELEASEES) from any and all liability, claims, demands, actions and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by me, or to any property belonging to me, while participating in physical activity, or while on or upon the Tifie Ranch premises. It is my expressed intent that this release and hold harmless agreement shall bind the members of my family and spouse, if I am alive, and my heirs, assigns and personal representative, if I am deceased, and shall be deemed as a RELEASE, WAIVER, DISCHARGE, and promise not to sue the above named RELEASEES.
I hereby further agree that this Waiver of Liability and Hold Harmless Agreement shall be constructed in accordance with the laws of the State of Utah. In signing this release, I acknowledge and represent that I HAVE READ THE FORGOING Waiver of Liability and Hold Harmless Agreement, UNDERSTAND IT AND SIGN IT VOLUNTARILY as my own free act and deed; no oral representations, statements or inducements, apart from the foregoing written agreements have been made; and I EXECUTE THIS RELEASE FOR FULL, ADEQUATE AND COMPLETE CONSIDERATION FULLY INTENDING TO BE BOUND BY SAME.
Name of Group: SUMMIT LEADERSHIP CAMP
Rules for Camp
These rules will make camp a great experience for everyone. Parents, please review and agree to these rules with your teen prior to camp.
Things to do
- Come with an open heart and a willingness to step out of your comfort zone.
- Respect others and honor their journey. Treat others with kindness and consideration. There is zero tolerance for bullying, harassment, or discrimination of any kind.
- Support your team.
- Actively participate in team activities and challenges even if it isn’t your thing.
- There will be a rotation of chores within your team facilitated by your Leader. These chores are not optional and are a part of team building and leadership.
- Be responsible:
- Be on time and be mentally present for all scheduled team and camp activities.
- Dress: Always wear shoes and shirts unless swimming or sailing.
- Eat responsibly: Take enough food and snacks, but don’t waste food.
- Stay hydrated! Drink a full water bottle before the day’s activities begin. Keep water with you.
- Maintain good personal hygiene by showering regularly and using appropriate toiletries
- Wipe the bathroom counter down after each use.
- Respect the 10pm quiet time, 10:30pm light out curfew and sleep. Allow others their sleep.
- Recycle whenever possible. Practice Leave No Trace Ethics: Keep your personal garbage (food wrappers, etc.) in a plastic bag in your pack or put it immediately into the recycling bins.
- Inspect your tent/campsite for trash or spilled food. Clean up any trash, food, and litter.
- Respect Nature: Do not feed, capture, or disturb the animals or intentionally damage plant life.
- Absolutely nothing goes down the toilets except toilet paper and human waste!!!
- Report issues: Notify camp staff promptly if you encounter any problems, conflicts, or concerns during your time at camp.
Things not to do
- Do not leave the designated camp boundaries except in the event of a supervised emergency. Your Leaders should be able to always locate you within camp boundaries.
- Do not be in a tent with a member of the opposite gender.
- Do not leave your tent after curfew unless you are sick or need the restroom. Please report to your group leader whenever you leave and return.
- Do not show any romantic affection to other students in public or private. Brief hugs are okay but snuggling, kissing, holding hands, and massages are not okay.
- Do not bring or possess illegal drugs, alcohol, tobacco, fireworks, firearms, weapons, or lighters.
- Do not do anything to harm yourself or others.
- Do not attempt to wade into or swim in the fast-running stream in camp. Use the bridges.
- Do not damage your tent or other parts of the camp facility.
Consequences:
Know that we have a zero-strikes policy. Participants who violate these rules will leave the activity or event and may have to find immediate transportation home.
By signing below you and your youth have reviewed these rules together and agree to abide by them.
