Please enable JavaScript in your browser to complete this form. – Step 1 of 3Ready to have some amazing fun?!Join us for Labor Day Camp 2025! Please allow yourself approximately 60 minutes to complete this form for a family of 4, including all medical and confidentiality forms. No mailing or printing required! NOTE: Do NOT close this form without clicking “Submit” or “Save and Resume Later” at the very end of the form. Otherwise all entries will be deleted with no way to recover them. Today's Date *Family Name *Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeMAIN CONTACT INFORMATION Last Name *First Name *Best Phone (cell phone preferred) *Email *EMERGENCY CONTACTEmergency Contact *Please list the name and contact information of an individual that we can contact should there be an emergency while at camp.Relationship to you *Phone Number *NextFAMILY INFORMATION Number of Family Members Attending Camp (Slide the circle to the right until desired number. You need to move this to be able to register everyone including yourself) Selected Value: 1 Select a value of 1 through 10 Attendee 1 Last Name *Please list the names of all family members attending (including yourself), and complete all of the required information for EACH camper. Every attendee must provide a medical form.First Name *Date of Birth *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender *MaleFemaleNon-BinaryGrade in SchoolRelationship to You *Self, Spouse, Child, Niece, Nephew, etc. T-shirt Size *YS, YM, YL, XS, S, M, L, XL, 2XL, 3XL, 4XLPhoto Release *Yes, this camper’s photo can be shownNo, this camper’s photo can not be shownPHOTO RELEASE: Please indicate the degree to which you release images of each camp participant, including yourself (note that you only have two options) – YES: I grant permission for REACH to use photographs/videos footage taken for public fundraising and publications. – NO: I decline permission for REACH to use photographs/video footage taken for any purpose. If your family was a dish, what would it be and why? *This will be used during introductions at opening ceremony. If you could have dinner with any historical figure, who would it be and why? *This will be used during introductions at opening ceremony. HEALTH INFORMATIONPlease provide the following information for Attendee 1 so that we may provide the best Camp experience possible!Please list any significant medical conditions. If none, write N/A. *Dietary Restrictions, including food allergies/intolerances. *The Camp meals are designed to offer delicious, varied and nutritionally sound choices, with options to meet most dietary restrictions. If you have other concerns and need to supplement meals with your own food, please contact REACH. REACH and the Camp facility are not responsible for meeting unique needs not disclosed in advance on this form.Allergies to medications *Other allergies *Restrictions (i.e. activities prohibited) *Other concerns. If none, write N/A. *Primary Care Physician Name *Primary Care Physician Phone Number *Primary Care Physician City & State *IMMUNIZATION HISTORYI verify that the above attendee’s immunizations are current according to the Washington State Requirements.Washington State Requirements Please contact the office if you have any questions at 253-383-7616 or cbryan@REACHministries.org.THE ATTENDEE IS BEHIND ON THE FOLLOWING IMMUNIZATIONS:MMR (Measles, Mumps, & Rubella)Hepatitis BDate of last Tetanus Shot *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Does this attendee have any signs or symptoms of active Tuberculosis infection? *YesNoDoes this attendee have a compromised immune system? *YesNoFor HIV-positive children, is the attendee aware of his/her status?YesNoAUTHORIZATION FOR PARTICIPATION AND MEDICAL TREATMENTI verify that I am age 18 or older, or am the parent or legal guardian of the youth named above and do hereby give my permission for me/him/her to engage in all activities excepted as noted by the examining physician and indicated on the medical health history and physical form. In consideration of the benefits to be derived, I expressly waive all claims against REACH Ministries, its staff, its officers, directors, trustees, volunteers, and their heirs and assign, on account of any accident, injury, and/or illness that may occur to myself or my child(ren) during camp, REACH sponsored activities, and/or in travel. I give permission to the physician selected by the camp, to order medical treatment for myself or my child in case of any emergency and in the treatment of pain and/or discomfort. I will be responsible for all costs incurred for care that is not provided by the REACH Camp. This Authorization is effective for one year from the date of signature.I attest to the above participation and medical treatment authorization for Attendee 1 *YesAttendee 2 Last Name *First Name *Date of Birth *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender *MaleFemaleNon-BinaryGrade in School *Relationship to You *Self, Spouse, Child, Niece, Nephew, etc. T-shirt Size *YS, YM, YL, XS, S, M, L, XL, 2XL, 3XL, 4XLPhoto Release *Yes, this camper’s photo can be shownNo, this camper’s photo can not be shownPHOTO RELEASE: Please indicate the degree to which you release images of each camp participant, including yourself (note that you only have two options) – YES: I grant permission for REACH to use photographs/videos footage taken for public fundraising and publications. – NO: I decline permission for REACH to use photographs/video footage taken for any purpose. If you could have dinner with any historical figure, who would it be and why? *This will be used during introductions at opening ceremony. HEALTH INFORMATION Please provide the following information for Attendee 2 so that we may provide the best Camp experience possible!Please list any significant medical conditions. If none, write N/A. *Dietary Restrictions, including food allergies/intolerances. *The Camp meals are designed to offer delicious, varied and nutritionally sound choices, with options to meet most dietary restrictions. If you have other concerns and need to supplement meals with your own food, please contact REACH. REACH and the Camp facility are not responsible for meeting unique needs not disclosed in advance on this form.Allergies to medications *Other allergies *Restrictions (i.e. activities prohibited) *Other concerns. If none, write N/A. *Primary Care Physician Name *Primary Care Physician Phone Number *Primary Care Physician City & State *IMMUNIZATION HISTORYI verify that the above attendee’s immunizations are current according to the Washington State Requirements.Washington State Requirements Please contact the office if you have any questions at 253-383-7616 or program@REACHministries.org.THE ATTENDEE IS BEHIND ON THE FOLLOWING IMMUNIZATIONS:MMR (Measles, Mumps, & Rubella)Hepatitis BDate of last Tetanus Shot *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Does this attendee have any signs or symptoms of active Tuberculosis infection? *YesNoDoes this attendee have a compromised immune system? *YesNoFor HIV-positive children, is the attendee aware of his/her status?YesNoAUTHORIZATION FOR PARTICIPATION AND MEDICAL TREATMENTI verify that I am age 18 or older, or am the parent or legal guardian of the youth named above and do hereby give my permission for me/him/her to engage in all activities excepted as noted by the examining physician and indicated on the medical health history and physical form. In consideration of the benefits to be derived, I expressly waive all claims against REACH Ministries, its staff, its officers, directors, trustees, volunteers, and their heirs and assign, on account of any accident, injury, and/or illness that may occur to myself or my child(ren) during camp, REACH sponsored activities, and/or in travel. I give permission to the physician selected by the camp, to order medical treatment for myself or my child in case of any emergency and in the treatment of pain and/or discomfort. I will be responsible for all costs incurred for care that is not provided by the REACH Camp. This Authorization is effective for one year from the date of signature.I attest to the above participation and medical treatment authorization for Attendee 2. *YesAttendee 3 Last Name *First Name *Date of Birth *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender *MaleFemaleNon-BinaryGrade in School *Relationship to You *Self, Spouse, Child, Niece, Nephew, etc. T-shirt Size *YS, YM, YL, XS, S, M, L, XL, 2XL, 3XL, 4XLPhoto Release *Yes, this camper’s photo can be shownNo, this camper’s photo can not be shownPHOTO RELEASE: Please indicate the degree to which you release images of each camp participant, including yourself (note that you only have two options) – YES: I grant permission for REACH to use photographs/videos footage taken for public fundraising and publications. – NO: I decline permission for REACH to use photographs/video footage taken for any purpose. If you could have dinner with any historical figure, who would it be and why? *This will be used during introductions at opening ceremony. HEALTH INFORMATION Please provide the following information for Attendee 3 so that we may provide the best Camp experience possible!Please list any significant medical conditions. If none, write N/A. *Dietary Restrictions, including food allergies/intolerances. *The Camp meals are designed to offer delicious, varied and nutritionally sound choices, with options to meet most dietary restrictions. If you have other concerns and need to supplement meals with your own food, please contact REACH. REACH and the Camp facility are not responsible for meeting unique needs not disclosed in advance on this form.Allergies to medications *Other allergies *Restrictions (i.e. activities prohibited) *Other concerns. If none, write N/A. *Primary Care Physician Name *Primary Care Physician Phone Number *Primary Care Physician City & State *IMMUNIZATION HISTORYI verify that the above attendee’s immunizations are current according to the Washington State Requirements.Washington State Requirements Please contact the office if you have any questions at 253-383-7616 or program@REACHministries.org.THE ATTENDEE IS BEHIND ON THE FOLLOWING IMMUNIZATIONS:MMR (Measles, Mumps, & Rubella)Hepatitis BDate of last Tetanus Shot *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Does this attendee have any signs or symptoms of active Tuberculosis infection? *YesNoDoes this attendee have a compromised immune system? *YesNoFor HIV-positive children, is the attendee aware of his/her status?YesNoAUTHORIZATION FOR PARTICIPATION AND MEDICAL TREATMENTI verify that I am age 18 or older, or am the parent or legal guardian of the youth named above and do hereby give my permission for me/him/her to engage in all activities excepted as noted by the examining physician and indicated on the medical health history and physical form. In consideration of the benefits to be derived, I expressly waive all claims against REACH Ministries, its staff, its officers, directors, trustees, volunteers, and their heirs and assign, on account of any accident, injury, and/or illness that may occur to myself or my child(ren) during camp, REACH sponsored activities, and/or in travel. I give permission to the physician selected by the camp, to order medical treatment for myself or my child in case of any emergency and in the treatment of pain and/or discomfort. I will be responsible for all costs incurred for care that is not provided by the REACH Camp. This Authorization is effective for one year from the date of signature.I attest to the above participation and medical treatment authorization for Attendee 3. *YesAttendee 4 Last Name *First Name *Date of Birth *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender *MaleFemaleNon-BinaryGrade in School *Relationship to You *Self, Spouse, Child, Niece, Nephew, etc. T-shirt Size *YS, YM, YL, XS, S, M, L, XL, 2XL, 3XL, 4XLPhoto Release *Yes, this camper’s photo can be shownNo, this camper’s photo can not be shownPHOTO RELEASE: Please indicate the degree to which you release images of each camp participant, including yourself (note that you only have two options) – YES: I grant permission for REACH to use photographs/videos footage taken for public fundraising and publications. – NO: I decline permission for REACH to use photographs/video footage taken for any purpose. If you could have dinner with any historical figure, who would it be and why? *This will be used during introductions at opening ceremony. HEALTH INFORMATIONPlease provide the following information for Attendee 4 so that we may provide the best Camp experience possible!Please list any significant medical conditions. If none, write N/A. *Dietary Restrictions, including food allergies/intolerances. *The Camp meals are designed to offer delicious, varied and nutritionally sound choices, with options to meet most dietary restrictions. If you have other concerns and need to supplement meals with your own food, please contact REACH. REACH and the Camp facility are not responsible for meeting unique needs not disclosed in advance on this form.Allergies to medications *Other allergies *Restrictions (i.e. activities prohibited) *Other concerns. If none, write N/A. *Primary Care Physician Name *Primary Care Physician Phone Number *Primary Care Physician City & State *IMMUNIZATION HISTORY I verify that the above attendee’s immunizations are current according to the Washington State Requirements.Washington State Requirements Please contact the office if you have any questions at 253-383-7616 or program@REACHministries.org.THE ATTENDEE IS BEHIND ON THE FOLLOWING IMMUNIZATIONS:MMR (Measles, Mumps, & Rubella)Hepatitis BDate of last Tetanus Shot *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Does this attendee have any signs or symptoms of active Tuberculosis infection? *YesNoDoes this attendee have a compromised immune system? *YesNoFor HIV-positive children, is the attendee aware of his/her status?YesNoAUTHORIZATION FOR PARTICIPATION AND MEDICAL TREATMENTI verify that I am age 18 or older, or am the parent or legal guardian of the youth named above and do hereby give my permission for me/him/her to engage in all activities excepted as noted by the examining physician and indicated on the medical health history and physical form. In consideration of the benefits to be derived, I expressly waive all claims against REACH Ministries, its staff, its officers, directors, trustees, volunteers, and their heirs and assign, on account of any accident, injury, and/or illness that may occur to myself or my child(ren) during camp, REACH sponsored activities, and/or in travel. I give permission to the physician selected by the camp, to order medical treatment for myself or my child in case of any emergency and in the treatment of pain and/or discomfort. I will be responsible for all costs incurred for care that is not provided by the REACH Camp. This Authorization is effective for one year from the date of signature.I attest to the above participation and medical treatment authorization for Attendee 4. *YesAttendee 5 Last Name *First Name *Date of Birth *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender *MaleFemaleNon-BinaryGrade in School *Relationship to You *Self, Spouse, Child, Niece, Nephew, etc. T-shirt Size *YS, YM, YL, XS, S, M, L, XL, 2XL, 3XL, 4XLPhoto Release *Yes, this camper’s photo can be shownNo, this camper’s photo can not be shownPHOTO RELEASE: Please indicate the degree to which you release images of each camp participant, including yourself (note that you only have two options) – YES: I grant permission for REACH to use photographs/videos footage taken for public fundraising and publications. – NO: I decline permission for REACH to use photographs/video footage taken for any purpose. If you could have dinner with any historical figure, who would it be and why? *This will be used during introductions at opening ceremony. HEALTH INFORMATIONPlease provide the following information for Attendee 5 so that we may provide the best Camp experience possible!Please list any significant medical conditions. If none, write N/A. *Dietary Restrictions, including food allergies/intolerances. *The Camp meals are designed to offer delicious, varied and nutritionally sound choices, with options to meet most dietary restrictions. If you have other concerns and need to supplement meals with your own food, please contact REACH. REACH and the Camp facility are not responsible for meeting unique needs not disclosed in advance on this form.Allergies to medications *Other allergies *Restrictions (i.e. activities prohibited) *Other concerns. If none, write N/A. *Primary Care Physician Name *Primary Care Physician Phone Number *Primary Care Physician City & State *IMMUNIZATION HISTORYI verify that the above attendee’s immunizations are current according to the Washington State Requirements.Washington State Requirements Please contact the office if you have any questions at 253-383-7616 or program@REACHministries.org.THE ATTENDEE IS BEHIND ON THE FOLLOWING IMMUNIZATIONS:MMR (Measles, Mumps, & Rubella)Hepatitis BDate of last Tetanus Shot *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Does this attendee have any signs or symptoms of active Tuberculosis infection? *YesNoDoes this attendee have a compromised immune system? *YesNoFor HIV-positive children, is the attendee aware of his/her status?YesNoAUTHORIZATION FOR PARTICIPATION AND MEDICAL TREATMENTI verify that I am age 18 or older, or am the parent or legal guardian of the youth named above and do hereby give my permission for me/him/her to engage in all activities excepted as noted by the examining physician and indicated on the medical health history and physical form. In consideration of the benefits to be derived, I expressly waive all claims against REACH Ministries, its staff, its officers, directors, trustees, volunteers, and their heirs and assign, on account of any accident, injury, and/or illness that may occur to myself or my child(ren) during camp, REACH sponsored activities, and/or in travel. I give permission to the physician selected by the camp, to order medical treatment for myself or my child in case of any emergency and in the treatment of pain and/or discomfort. I will be responsible for all costs incurred for care that is not provided by the REACH Camp. This Authorization is effective for one year from the date of signature.I attest to the above participation and medical treatment authorization for Attendee 5. *YesAttendee 6 Last Name *First Name *Date of Birth *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender *MaleFemaleNon-BinaryGrade in School *Relationship to You *Self, Spouse, Child, Niece, Nephew, etc. T-shirt Size *YS, YM, YL, XS, S, M, L, XL, 2XL, 3XL, 4XLPhoto Release *Yes, this camper’s photo can be shownNo, this camper’s photo can not be shownPHOTO RELEASE: Please indicate the degree to which you release images of each camp participant, including yourself (note that you only have two options) – YES: I grant permission for REACH to use photographs/videos footage taken for public fundraising and publications. – NO: I decline permission for REACH to use photographs/video footage taken for any purpose. If you could have dinner with any historical figure, who would it be and why? *This will be used during introductions at opening ceremony. HEALTH INFORMATIONPlease provide the following information for Attendee 6 so that we may provide the best Camp experience possible!Please list any significant medical conditions. If none, write N/A. *Dietary Restrictions, including food allergies/intolerances. *The Camp meals are designed to offer delicious, varied and nutritionally sound choices, with options to meet most dietary restrictions. If you have other concerns and need to supplement meals with your own food, please contact REACH. REACH and the Camp facility are not responsible for meeting unique needs not disclosed in advance on this form.Allergies to medications *Other allergies *Restrictions (i.e. activities prohibited) *Other concerns. If none, write N/A. *Primary Care Physician Name *Primary Care Physician Phone Number *Primary Care Physician City & State *IMMUNIZATION HISTORYI verify that the above attendee’s immunizations are current according to the Washington State Requirements.Washington State Requirements Please contact the office if you have any questions at 253-383-7616 or program@REACHministries.org.THE ATTENDEE IS BEHIND ON THE FOLLOWING IMMUNIZATIONS:MMR (Measles, Mumps, & Rubella)Hepatitis BDate of last Tetanus Shot *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Does this attendee have any signs or symptoms of active Tuberculosis infection? *YesNoDoes this attendee have a compromised immune system? *YesNoFor HIV-positive children, is the attendee aware of his/her status?YesNoAUTHORIZATION FOR PARTICIPATION AND MEDICAL TREATMENTI verify that I am age 18 or older, or am the parent or legal guardian of the youth named above and do hereby give my permission for me/him/her to engage in all activities excepted as noted by the examining physician and indicated on the medical health history and physical form. In consideration of the benefits to be derived, I expressly waive all claims against REACH Ministries, its staff, its officers, directors, trustees, volunteers, and their heirs and assign, on account of any accident, injury, and/or illness that may occur to myself or my child(ren) during camp, REACH sponsored activities, and/or in travel. I give permission to the physician selected by the camp, to order medical treatment for myself or my child in case of any emergency and in the treatment of pain and/or discomfort. I will be responsible for all costs incurred for care that is not provided by the REACH Camp. This Authorization is effective for one year from the date of signature.I attest to the above participation and medical treatment authorization for Attendee 6. *YesAttendee 7 Last Name *First Name *Date of Birth *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender *MaleFemaleNon-BinaryGrade in School *Relationship to You *Self, Spouse, Child, Niece, Nephew, etc. T-shirt Size *YS, YM, YL, XS, S, M, L, XL, 2XL, 3XL, 4XLPhoto Release *Yes, this camper’s photo can be shownNo, this camper’s photo can not be shownPHOTO RELEASE: Please indicate the degree to which you release images of each camp participant, including yourself (note that you only have two options) – YES: I grant permission for REACH to use photographs/videos footage taken for public fundraising and publications. – NO: I decline permission for REACH to use photographs/video footage taken for any purpose. If you could have dinner with any historical figure, who would it be and why? *This will be used during introductions at opening ceremony. HEALTH INFORMATIONPlease provide the following information for Attendee 7 so that we may provide the best Camp experience possible!Please list any significant medical conditions. If none, write N/A. *Dietary Restrictions, including food allergies/intolerances. *The Camp meals are designed to offer delicious, varied and nutritionally sound choices, with options to meet most dietary restrictions. If you have other concerns and need to supplement meals with your own food, please contact REACH. REACH and the Camp facility are not responsible for meeting unique needs not disclosed in advance on this form.Allergies to medications *Other allergies *Restrictions (i.e. activities prohibited) *Other concerns. If none, write N/A. *Primary Care Physician Name *Primary Care Physician Phone Number *Primary Care Physician City & State *IMMUNIZATION HISTORYI verify that the above attendee’s immunizations are current according to the Washington State Requirements.Washington State Requirements Please contact the office if you have any questions at 253-383-7616 or program@REACHministries.org.THE ATTENDEE IS BEHIND ON THE FOLLOWING IMMUNIZATIONS:MMR (Measles, Mumps, & Rubella)Hepatitis BDate of last Tetanus Shot *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Does this attendee have any signs or symptoms of active Tuberculosis infection? *YesNoDoes this attendee have a compromised immune system? *YesNoFor HIV-positive children, is the attendee aware of his/her status?YesNoAUTHORIZATION FOR PARTICIPATION AND MEDICAL TREATMENTI verify that I am age 18 or older, or am the parent or legal guardian of the youth named above and do hereby give my permission for me/him/her to engage in all activities excepted as noted by the examining physician and indicated on the medical health history and physical form. In consideration of the benefits to be derived, I expressly waive all claims against REACH Ministries, its staff, its officers, directors, trustees, volunteers, and their heirs and assign, on account of any accident, injury, and/or illness that may occur to myself or my child(ren) during camp, REACH sponsored activities, and/or in travel. I give permission to the physician selected by the camp, to order medical treatment for myself or my child in case of any emergency and in the treatment of pain and/or discomfort. I will be responsible for all costs incurred for care that is not provided by the REACH Camp. This Authorization is effective for one year from the date of signature.I attest to the above participation and medical treatment authorization for Attendee 7. *YesAttendee 8 Last Name *First Name *Date of Birth *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender *MaleFemaleNon-BinaryGrade in School *Relationship to You *Self, Spouse, Child, Niece, Nephew, etc. T-shirt Size *YS, YM, YL, XS, S, M, L, XL, 2XL, 3XL, 4XLPhoto Release *Yes, this camper’s photo can be shownNo, this camper’s photo can not be shownPHOTO RELEASE: Please indicate the degree to which you release images of each camp participant, including yourself (note that you only have two options) – YES: I grant permission for REACH to use photographs/videos footage taken for public fundraising and publications. – NO: I decline permission for REACH to use photographs/video footage taken for any purpose. If you could have dinner with any historical figure, who would it be and why? *This will be used during introductions at opening ceremony. HEALTH INFORMATIONPlease provide the following information for Attendee 8 so that we may provide the best Camp experience possible!Please list any significant medical conditions. If none, write N/A. *Dietary Restrictions, including food allergies/intolerances. *The Camp meals are designed to offer delicious, varied and nutritionally sound choices, with options to meet most dietary restrictions. If you have other concerns and need to supplement meals with your own food, please contact REACH. REACH and the Camp facility are not responsible for meeting unique needs not disclosed in advance on this form.Allergies to medications *Other allergies *Restrictions (i.e. activities prohibited) *Other concerns. If none, write N/A. *Primary Care Physician Name *Primary Care Physician Phone Number *Primary Care Physician City & State *IMMUNIZATION HISTORYI verify that the above attendee’s immunizations are current according to the Washington State Requirements.Washington State Requirements Please contact the office if you have any questions at 253-383-7616 or program@REACHministries.org.THE ATTENDEE IS BEHIND ON THE FOLLOWING IMMUNIZATIONS: MMR (Measles, Mumps, & Rubella)Hepatitis BDate of last Tetanus Shot *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Does this attendee have any signs or symptoms of active Tuberculosis infection? *YesNoDoes this attendee have a compromised immune system? *YesNoFor HIV-positive children, is the attendee aware of his/her status?YesNoAUTHORIZATION FOR PARTICIPATION AND MEDICAL TREATMENTI verify that I am age 18 or older, or am the parent or legal guardian of the youth named above and do hereby give my permission for me/him/her to engage in all activities excepted as noted by the examining physician and indicated on the medical health history and physical form. In consideration of the benefits to be derived, I expressly waive all claims against REACH Ministries, its staff, its officers, directors, trustees, volunteers, and their heirs and assign, on account of any accident, injury, and/or illness that may occur to myself or my child(ren) during camp, REACH sponsored activities, and/or in travel. I give permission to the physician selected by the camp, to order medical treatment for myself or my child in case of any emergency and in the treatment of pain and/or discomfort. I will be responsible for all costs incurred for care that is not provided by the REACH Camp. This Authorization is effective for one year from the date of signature.I attest to the above participation and medical treatment authorization for Attendee 8. *YesAttendee 9 Last Name *First Name *Date of Birth *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender *MaleFemaleNon-BinaryGrade in School *Relationship to You *Self, Spouse, Child, Niece, Nephew, etc. T-shirt Size *YS, YM, YL, XS, S, M, L, XL, 2XL, 3XL, 4XLPhoto Release *Yes, this camper’s photo can be shownNo, this camper’s photo can not be shownPHOTO RELEASE: Please indicate the degree to which you release images of each camp participant, including yourself (note that you only have two options) – YES: I grant permission for REACH to use photographs/videos footage taken for public fundraising and publications. – NO: I decline permission for REACH to use photographs/video footage taken for any purpose. If you could have dinner with any historical figure, who would it be and why? *This will be used during introductions at opening ceremony. HEALTH INFORMATIONPlease provide the following information for Attendee 9 so that we may provide the best Camp experience possible!Please list any significant medical conditions. If none, write N/A. *Dietary Restrictions, including food allergies/intolerances. *The Camp meals are designed to offer delicious, varied and nutritionally sound choices, with options to meet most dietary restrictions. If you have other concerns and need to supplement meals with your own food, please contact REACH. REACH and the Camp facility are not responsible for meeting unique needs not disclosed in advance on this form.Allergies to medications *Other allergies *Restrictions (i.e. activities prohibited) *Other concerns. If none, write N/A. *Primary Care Physician Name *Primary Care Physician Phone Number *Primary Care Physician City & State *IMMUNIZATION HISTORYI verify that the above attendee’s immunizations are current according to the Washington State Requirements.Washington State Requirements Please contact the office if you have any questions at 253-383-7616 or program@REACHministries.org.THE ATTENDEE IS BEHIND ON THE FOLLOWING IMMUNIZATIONS: MMR (Measles, Mumps, & Rubella)Hepatitis BDate of last Tetanus Shot *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Does this attendee have any signs or symptoms of active Tuberculosis infection? *YesNoDoes this attendee have a compromised immune system? *YesNoFor HIV-positive children, is the attendee aware of his/her status?YesNoAUTHORIZATION FOR PARTICIPATION AND MEDICAL TREATMENTI verify that I am age 18 or older, or am the parent or legal guardian of the youth named above and do hereby give my permission for me/him/her to engage in all activities excepted as noted by the examining physician and indicated on the medical health history and physical form. In consideration of the benefits to be derived, I expressly waive all claims against REACH Ministries, its staff, its officers, directors, trustees, volunteers, and their heirs and assign, on account of any accident, injury, and/or illness that may occur to myself or my child(ren) during camp, REACH sponsored activities, and/or in travel. I give permission to the physician selected by the camp, to order medical treatment for myself or my child in case of any emergency and in the treatment of pain and/or discomfort. I will be responsible for all costs incurred for care that is not provided by the REACH Camp. This Authorization is effective for one year from the date of signature.I attest to the above participation and medical treatment authorization for Attendee 9. *YesAttendee 10 Last Name *First Name *Date of Birth *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender *MaleFemaleNon-BinaryGrade in School *(N/A if no longer in school.)Relationship to You *Self, Spouse, Child, Niece, Nephew, etc. T-shirt Size *YS, YM, YL, XS, S, M, L, XL, 2XL, 3XL, 4XLPhoto Release *Yes, this camper’s photo can be shownNo, this camper’s photo can not be shownPHOTO RELEASE: Please indicate the degree to which you release images of each camp participant, including yourself (note that you only have two options) – YES: I grant permission for REACH to use photographs/videos footage taken for public fundraising and publications. – NO: I decline permission for REACH to use photographs/video footage taken for any purpose. If you could have dinner with any historical figure, who would it be and why? *This will be used during introductions at opening ceremony. HEALTH INFORMATIONPlease provide the following information for Attendee 10 so that we may provide the best Camp experience possible!Please list any significant medical conditions. If none, write N/A. *Dietary Restrictions, including food allergies/intolerances. *The Camp meals are designed to offer delicious, varied and nutritionally sound choices, with options to meet most dietary restrictions. If you have other concerns and need to supplement meals with your own food, please contact REACH. REACH and the Camp facility are not responsible for meeting unique needs not disclosed in advance on this form.Allergies to medications *Other allergies *Restrictions (i.e. activities prohibited) *Other concerns. If none, write N/A. *Primary Care Physician Name *Primary Care Physician Phone Number *Primary Care Physician City & State *IMMUNIZATION HISTORY I verify that the above attendee’s immunizations are current according to the Washington State Requirements.Washington State Requirements Please contact the office if you have any questions at 253-383-7616 or program@REACHministries.org.THE ATTENDEE IS BEHIND ON THE FOLLOWING IMMUNIZATIONS: MMR (Measles, Mumps, & Rubella)Hepatitis BDate of last Tetanus Shot *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Does this attendee have any signs or symptoms of active Tuberculosis infection? *YesNoDoes this attendee have a compromised immune system? *YesNoFor HIV-positive children, is the attendee aware of his/her status?YesNoAUTHORIZATION FOR PARTICIPATION AND MEDICAL TREATMENTI verify that I am age 18 or older, or am the parent or legal guardian of the youth named above and do hereby give my permission for me/him/her to engage in all activities excepted as noted by the examining physician and indicated on the medical health history and physical form. In consideration of the benefits to be derived, I expressly waive all claims against REACH Ministries, its staff, its officers, directors, trustees, volunteers, and their heirs and assign, on account of any accident, injury, and/or illness that may occur to myself or my child(ren) during camp, REACH sponsored activities, and/or in travel. I give permission to the physician selected by the camp, to order medical treatment for myself or my child in case of any emergency and in the treatment of pain and/or discomfort. I will be responsible for all costs incurred for care that is not provided by the REACH Camp. This Authorization is effective for one year from the date of signature.I attest to the above participation and medical treatment authorization for Attendee 10. *Yes – END OF CAMPER ENTRIES –You made it! Please continue on to answer the final few questions of the registration form. Thank you! NextARRIVAL AND DEPARTURE Family check in starts at 5:00 pm Friday, August 30th. What time do you plan to arrive and depart?Arrival *FridaySaturdayOther (please comment)Estimated Arrival TimeComments:Departure *MondayOther (please comment)Expected Departure TimeComments:CONFIDENTIALITY CONTRACTThe following statements are non-negotiable for participants in REACH programs and events. 1. Confidentiality is to be maintained at all times. • Do not reveal the first or last names of REACH family members to anyone outside the context of REACH. • Do not reveal the location of any REACH event or any REACH contact’s home, school, or work. • Do not repeat sensitive conversations between REACH participants. 2. If you plan to continue a relationship with a REACH family member/volunteer outside the context of a REACH event, please respect the following guidelines: • Exercise caution when utilizing Facebook and social networking sites. • Do not label pictures with a child’s first or last name. • Do not label pictures using the term “REACH”. Use generic descriptors like “friends at camp”. • Any solicitation for personal purposes (i.e. offering services such as counseling, physician referrals, hospital care, etc.) must be authorized by the REACH Program Director. 3. All guests must be cleared by the REACH Program Director prior to visitation. 4. No publications, presentations or media releases of any kind in association with REACH families are allowed without prior approval or collaboration with the REACH Program Director. 5. Individuals not adhering to this contract will not be allowed to participate. If there are any questions about this policy, please consult REACH Staff for further explanation.Each family member has read and agrees to the Confidentiality Contract *YesBy clicking “Yes,” I attest that all family members have read and understand REACH Ministries’ Confidentiality Contract.GUEST POLICY As the REACH community continues to grow, we must be intentional about deciding when REACH family members may bring a guest. Guests must be pre-approved by the REACH staff. You may review the REACH Guest Policy and submit a guest request by clicking here. Please contact the office if you have any questions at 253-383-7616 or cbryan@REACHministries.org.REGISTRATION FEE AND POLICYThe registration fee for each family member attending is $40 with a cap of $200 for the family, regardless of number. Scholarships are available. Please do not let financial reasons keep you from attending camp. Contact the REACH office to discuss a scholarship at 253-383-7616 or cbryan@REACHministries.org. Once you click on the submit button, you will be redirected to make your payment on our secure site. On that site you may also make a gift to support scholarships for other families. You can also mail your payment to: REACH Ministries 310 North K Street, Suite 200, Tacoma, WA 98403. THANK YOU! We look forward to seeing you very soon.Submit