Labor Day Registration - REACH Ministries

FAMILY 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 *

Gender *

Male
Female
Non-Binary

Grade in School

Relationship to You *

Self, Spouse, Child, Niece, Nephew, etc.

T-shirt Size *

YS, YM, YL, XS, S, M, L, XL, 2XL, 3XL, 4XL

Photo Release *

Yes, this camper’s photo can be shown
No, this camper’s photo can not be shown

PHOTO 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 INFORMATION

Please 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 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 cbryan@REACHministries.org.

THE ATTENDEE IS BEHIND ON THE FOLLOWING IMMUNIZATIONS:

MMR (Measles, Mumps, & Rubella)
Hepatitis B

Date of last Tetanus Shot *

Does this attendee have any signs or symptoms of active Tuberculosis infection? *

Yes
No

Does this attendee have a compromised immune system? *

Yes
No

For HIV-positive children, is the attendee aware of his/her status?

Yes
No

AUTHORIZATION FOR PARTICIPATION AND MEDICAL TREATMENT

I 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 *

Yes

Attendee 2 Last Name *

First Name *

Date of Birth *

Gender *

Male
Female
Non-Binary

Grade in School *

Relationship to You *

Self, Spouse, Child, Niece, Nephew, etc.

T-shirt Size *

YS, YM, YL, XS, S, M, L, XL, 2XL, 3XL, 4XL

Photo Release *

Yes, this camper’s photo can be shown
No, this camper’s photo can not be shown

PHOTO 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 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 B

Date of last Tetanus Shot *

Does this attendee have any signs or symptoms of active Tuberculosis infection? *

Yes
No

Does this attendee have a compromised immune system? *

Yes
No

For HIV-positive children, is the attendee aware of his/her status?

Yes
No

AUTHORIZATION FOR PARTICIPATION AND MEDICAL TREATMENT

I 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. *

Yes

Attendee 3 Last Name *

First Name *

Date of Birth *

Gender *

Male
Female
Non-Binary

Grade in School *

Relationship to You *

Self, Spouse, Child, Niece, Nephew, etc.

T-shirt Size *

YS, YM, YL, XS, S, M, L, XL, 2XL, 3XL, 4XL

Photo Release *

Yes, this camper’s photo can be shown
No, this camper’s photo can not be shown

PHOTO 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 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 B

Date of last Tetanus Shot *

Does this attendee have any signs or symptoms of active Tuberculosis infection? *

Yes
No

Does this attendee have a compromised immune system? *

Yes
No

For HIV-positive children, is the attendee aware of his/her status?

Yes
No

AUTHORIZATION FOR PARTICIPATION AND MEDICAL TREATMENT

I 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. *

Yes

Attendee 4 Last Name *

First Name *

Date of Birth *

Gender *

Male
Female
Non-Binary

Grade in School *

Relationship to You *

Self, Spouse, Child, Niece, Nephew, etc.

T-shirt Size *

YS, YM, YL, XS, S, M, L, XL, 2XL, 3XL, 4XL

Photo Release *

Yes, this camper’s photo can be shown
No, this camper’s photo can not be shown

PHOTO 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 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 B

Date of last Tetanus Shot *

Does this attendee have any signs or symptoms of active Tuberculosis infection? *

Yes
No

Does this attendee have a compromised immune system? *

Yes
No

For HIV-positive children, is the attendee aware of his/her status?

Yes
No

AUTHORIZATION FOR PARTICIPATION AND MEDICAL TREATMENT

I 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. *

Yes

Attendee 5 Last Name *

First Name *

Date of Birth *

Gender *

Male
Female
Non-Binary

Grade in School *

Relationship to You *

Self, Spouse, Child, Niece, Nephew, etc.

T-shirt Size *

YS, YM, YL, XS, S, M, L, XL, 2XL, 3XL, 4XL

Photo Release *

Yes, this camper’s photo can be shown
No, this camper’s photo can not be shown

PHOTO 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 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 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 B

Date of last Tetanus Shot *

Does this attendee have any signs or symptoms of active Tuberculosis infection? *

Yes
No

Does this attendee have a compromised immune system? *

Yes
No

For HIV-positive children, is the attendee aware of his/her status?

Yes
No

AUTHORIZATION FOR PARTICIPATION AND MEDICAL TREATMENT

I 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. *

Yes

Attendee 6 Last Name *

First Name *

Date of Birth *

Gender *

Male
Female
Non-Binary

Grade in School *

Relationship to You *

Self, Spouse, Child, Niece, Nephew, etc.

T-shirt Size *

YS, YM, YL, XS, S, M, L, XL, 2XL, 3XL, 4XL

Photo Release *

Yes, this camper’s photo can be shown
No, this camper’s photo can not be shown

PHOTO 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 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 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 B

Date of last Tetanus Shot *

Does this attendee have any signs or symptoms of active Tuberculosis infection? *

Yes
No

Does this attendee have a compromised immune system? *

Yes
No

For HIV-positive children, is the attendee aware of his/her status?

Yes
No

AUTHORIZATION FOR PARTICIPATION AND MEDICAL TREATMENT

I 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. *

Yes

Attendee 7 Last Name *

First Name *

Date of Birth *

Gender *

Male
Female
Non-Binary

Grade in School *

Relationship to You *

Self, Spouse, Child, Niece, Nephew, etc.

T-shirt Size *

YS, YM, YL, XS, S, M, L, XL, 2XL, 3XL, 4XL

Photo Release *

Yes, this camper’s photo can be shown
No, this camper’s photo can not be shown

PHOTO 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 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 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 B

Date of last Tetanus Shot *

Does this attendee have any signs or symptoms of active Tuberculosis infection? *

Yes
No

Does this attendee have a compromised immune system? *

Yes
No

For HIV-positive children, is the attendee aware of his/her status?

Yes
No

AUTHORIZATION FOR PARTICIPATION AND MEDICAL TREATMENT

I 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. *

Yes

Attendee 8 Last Name *

First Name *

Date of Birth *

Gender *

Male
Female
Non-Binary

Grade in School *

Relationship to You *

Self, Spouse, Child, Niece, Nephew, etc.

T-shirt Size *

YS, YM, YL, XS, S, M, L, XL, 2XL, 3XL, 4XL

Photo Release *

Yes, this camper’s photo can be shown
No, this camper’s photo can not be shown

PHOTO 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 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 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 B

Date of last Tetanus Shot *

Does this attendee have any signs or symptoms of active Tuberculosis infection? *

Yes
No

Does this attendee have a compromised immune system? *

Yes
No

For HIV-positive children, is the attendee aware of his/her status?

Yes
No

AUTHORIZATION FOR PARTICIPATION AND MEDICAL TREATMENT

I 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. *

Yes

Attendee 9 Last Name *

First Name *

Date of Birth *

Gender *

Male
Female
Non-Binary

Grade in School *

Relationship to You *

Self, Spouse, Child, Niece, Nephew, etc.

T-shirt Size *

YS, YM, YL, XS, S, M, L, XL, 2XL, 3XL, 4XL

Photo Release *

Yes, this camper’s photo can be shown
No, this camper’s photo can not be shown

PHOTO 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 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 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 B

Date of last Tetanus Shot *

Does this attendee have any signs or symptoms of active Tuberculosis infection? *

Yes
No

Does this attendee have a compromised immune system? *

Yes
No

For HIV-positive children, is the attendee aware of his/her status?

Yes
No

AUTHORIZATION FOR PARTICIPATION AND MEDICAL TREATMENT

I 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. *

Yes

Attendee 10 Last Name *

First Name *

Date of Birth *

Gender *

Male
Female
Non-Binary

Grade 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, 4XL

Photo Release *

Yes, this camper’s photo can be shown
No, this camper’s photo can not be shown

PHOTO 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 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 B

Date of last Tetanus Shot *

Does this attendee have any signs or symptoms of active Tuberculosis infection? *

Yes
No

Does this attendee have a compromised immune system? *

Yes
No

For HIV-positive children, is the attendee aware of his/her status?

Yes
No

AUTHORIZATION FOR PARTICIPATION AND MEDICAL TREATMENT

I 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!

Ready to have some amazing fun?!

MAIN CONTACT INFORMATION

EMERGENCY CONTACT

FAMILY INFORMATION

HEALTH INFORMATION

AUTHORIZATION FOR PARTICIPATION AND MEDICAL TREATMENT

HEALTH INFORMATION

AUTHORIZATION FOR PARTICIPATION AND MEDICAL TREATMENT

HEALTH INFORMATION

AUTHORIZATION FOR PARTICIPATION AND MEDICAL TREATMENT

HEALTH INFORMATION

AUTHORIZATION FOR PARTICIPATION AND MEDICAL TREATMENT

HEALTH INFORMATION

AUTHORIZATION FOR PARTICIPATION AND MEDICAL TREATMENT

HEALTH INFORMATION

AUTHORIZATION FOR PARTICIPATION AND MEDICAL TREATMENT

HEALTH INFORMATION

AUTHORIZATION FOR PARTICIPATION AND MEDICAL TREATMENT

HEALTH INFORMATION

AUTHORIZATION FOR PARTICIPATION AND MEDICAL TREATMENT

HEALTH INFORMATION

AUTHORIZATION FOR PARTICIPATION AND MEDICAL TREATMENT

HEALTH INFORMATION

AUTHORIZATION FOR PARTICIPATION AND MEDICAL TREATMENT

– END OF CAMPER ENTRIES –

ARRIVAL AND DEPARTURE

CONFIDENTIALITY CONTRACT

GUEST POLICY

REGISTRATION FEE AND POLICY

COMMITMENT TO TRANSPARENCY

REACH MINISTRIES

Follow us on Facebook