Rau-Wood 2022 Registration Form

Trinity Hosts

Camp Rau-Wood

(in Nashville)

For completed 3^rd-8th Grades

AND High School Counselors

^{June 19th-21st}(Monday-Wed)

Cost $50

Form and Payment due by Sunday,

June 5^th

Participants Name

Age

Grade Completed

T-Shirt Size

Home Church

Participation Permission

I give permission for my youth(s) to participate in Trinity’s 2023 Camp Rau-Wood in Nashville, TN. I understand this is an overnight event (2 nights) where staff will take care of my children. The attendee does hereby release and forever discharge and hold harmless the staff for this camp retreat at Rau-Wood and its affiliate organization (Trinity Lutheran Church) from any and all liability, claims, and demands of whatever kind of nature, either in law or in equity, which may arise from participating in this event.

Photo Permission
I give my permission for any photos or video taken at Trinity related events to be used on websites and newsletter and display.

Transportation Permission (for Emergencies only)

I give permission for the appointed drivers to drive my child/children to and from the event, and in the case of an emergency. The attendee does hereby release and forever discharge and hold harmless the drivers and its affiliate organization (Trinity Lutheran Church) from any and all liability, claims, and demands of whatever kind of nature, either in law or in equity, which may arise from participating in this event. In other words, I will not hold the drivers or the church responsible should an accident occur.

In Case of EMERGENCY

In the event of an illness or accident that requires immediate medical treatment I give permission for an approved representative of Trinity Lutheran Church to authorize such treatment. I will not hold the church or medical personnel responsible. In signing this I understand that every attempt will be made to contact me or the alternate emergency contact.

Please also fill out the Medical Treatment Form and Release of All Claims Form attached

MEDICAL TREATMENT FORM for TRINITY’S YOUTH CAMP AT RAU-WOOD 2023 RELEASE OF ALL CLAIMS In consideration of being accepted by Trinity Lutheran Church, the Southeastern Synod, ELCA for participation in youth ministry events, I (we) do for myself (ourselves) an on behalf of my child/participant do hereby release, forever discharge, and agree to forever hold harmless Trinity Lutheran Church, it’s staff for this event, the Southeastern Synod, ELCA, the employees, and agents thereof, from any and all liability, claims and demands for personal injury, sickness and death, as well as property damage and expenses of any nature whatsoever which may be incurred by me or my child/participant resulting from said child’s participation in Trinity Lutheran Churches’ sponsored youth events, including travel, recreation and all associated activities. Further, I (we) (and on behalf of our child/participant under 18 years of age) hereby assume all risk of said personal injury, sickness, death, damage and expenses as a result of participation as above set forth. I also understand that staff and volunteers are responsible for the administration of prescribed medication and I (we) have made private arrangements for any medication taken on a daily schedule by my child/participant. I (we) am (are) the parent(s) or legal guardian(s) of this participant, and hereby grant my (our) permission for him/her to participate fully in said youth events, and give my (our) permission to take said to a doctor or hospital, share the above medical information and authorize medical treatment, including, but not limited to emergency surgery or medical treatment, and assume responsibility of all medical bills incurred by my child. I (we) give permission for my child to receive over the counter medication such as Tylenol, ibuprofen, antidiarrheal medication, antibacterial ointment, throat lozenges, eye wash solution, and the like. I (we) also release the participant’s name as part of an information database for Trinity Lutheran Church, the Southeastern Synod and ELCA related entities, and grant Trinity Lutheran Church, the Southeastern Synod and ELCA unrestricted rights to use, alter, and reproduce any images (still and video) from the event, in any medium without compensation. DATE

PARENT/LEGAL GUARDIAN’S SIGNATURE

PLEASE ATTACH PHOTOCOPY OF MEDICAL INSURANCE CARD -OR- COMPLETE BELOW:

Click to attach scanned copy of insurance card or fill in blanks below

Upload (8MB)

Insurance Company

Insurance company phone #

Policy Number

Policy Holder Name:

Member #:

Group #:

Parental Information

Mother/Father/Legal Guardian

Cell #

This address will receive a confirmation email

Other Emergency Contact

Relationship

Cell Phone:

Allergies:

Restrictions on diet or exercise

Special needs of any sort? If so, please list:

Is the participant on regular medication? If so, please list the drugs, dosages, frequency and any instructions:

Payment

PAYMENT OPTIONS

You may submit Credit Card payment with this form.

You may pay by Personal Check or Church Check.

Make Checks out to Trinity Lutheran with Rau-Wood in the Memo Line. Mail to Trinity Lutheran at 320 Druid Lane, Tullahoma, TN 37388 BY June 5th.

Scholarships Available Upon Request

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Rau-Wood 2022 Registration Form

Description

Please Fix the Following