Clone of FIRE Summer Camp Counselor Registration Form
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  • FIRE CAMP Counselor Application 2026

    Monday June 15th- Friday June 19th
  • Counselor Name

  • Gender*
  • Camper Shirt Size*

  • While the T shirts are included in the cost of camp, a camp hoodie can be purchased at an additional cost of $35 and will be given to you at the time of camp check in! COMPLETELY OPTIONAL!

  • Camper Shirt Size

  • Counselor Information

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  • Church Information

  • Email Confirmation

  • Health Information

    A health officer is on site at all times.
  • It is our policy to contact the parent or guardian as soon as possible in the event of a serious accident or injury.  If the information has changed on the day of registration please see the health officer at that time.  Please bring all medication in ORGIANAL CONTAINER or you will not be allowed to leave the medication or vitamins at the camp.  No exceptions.  All prescriptions must be in that campers name and the correct dosage.  

    In case of emergency, I hereby give permission to the physician/healthcare professional selected by the Tower of Faith Youth Department, their assigned agent, or the hosting camp to hospitalize, secure proper treatment for, and order injection, anesthesia, or surgery for my child/the camper as named above. It is understood that Tower of Faith Youth Department, the hosting camp, and doctor will make every effort to contact the parent/guardian of the child before treatment.

    I, the parent, agree that I am and will obtain full financial responsibility for my child’s/the camper named above medical care expenses.

    PHOTOGRAPHY: Registering for camp gives Champions permission to use your child’s likeness in print and video on the internet for promotional purposes.

    OFF-SITE TRANSPORTATION: Registering for camp gives Tower of Faith Youth Department permission to transport your child to off-site activities if applicable.

    DISCIPLINE POLICY: I understand that my child comes under the authority and reasonable guidelines of Tower of Faith Youth Department and may be sent home in the event of a violation of the rules. If this should occur, I agree to come get my child immediately and at my own expense.

    PARTICIPATION, RELEASE, WAIVER & INDEMNITY AGREEMENT

    WHILE TOWER OF FAITH CHURCH, FIRE YOUTH DEPARTMENT, AND OUR HOSTING CAMP LOCATION MAKE EVERY EFFORT TO PROVIDE A SAFE AND PLEASANT ENVIRONMENT FOR YOUR CHILD, WE DO REQUIRE THAT THIS PARTICIPATION AGREEMENT BE READ, FILLED OUT, SIGNED, AND DATED BY THE PARENT OR LEGAL GUARDIAN OF EACH CHILD UNDER 18 YEARS OF AGE WHO WISHES TO PARTICIPATE IN THE ACTIVITIES WHICH OCCUR AT OUR HOSTING CAMP LOCATION.

    I, the undersigned, give permission for the camper to participate in the activities that occur at the camp venue chosen by Tower of Faith Youth Department. These activities include, but are not limited to, swimming, hiking, climbing, archery, disc golf, tetherball, horseshoes, and strenuous competition games. I grant this permission with full knowledge that I accept full responsibility for any injury or accident that may occur.

    Although Tower of Faith Youth Department and the hosting camp have taken reasonable steps to provide equipment and skilled employees so your child can participate in activities in which he/she may not be skilled in, we now remind you that these activities are not without risk. Certain risks cannot be eliminated due to the camp’s rural setting without destroying the unique character of those activities. The same elements that contribute to the character of these activities can be the cause of loss or damage to your property, accidental injury, illness, or in extreme cases, permanent trauma, or death. We do not want to frighten you or reduce your enthusiasm for these activities, but we do think it is important for you to be informed and know in advance about the inherent risks.

    I, on behalf of myself, my children, my assigns, and my estate agree to release and hold harmless Tower of Faith Youth Department and all hosting camps, its officers, Board, agents, or employees, for all claims for injuries, causes of action, or liability related to my child’s participation in any activity occurring while in Tower of Faith Youth Department care or on or around the hosting camp’s grounds. This release does not apply to intentional and/or willful acts of misconduct by Tower of Faith Youth Department or the hosting camp, or any of its officers, Board, agents, or employees.

    Should Tower of Faith Youth Department., the hosting camp, or anyone acting on their behalf, be required to incur attorneys’ fees and costs to enforce this agreement, I agree to indemnify and hold Tower of Faith Youth Department, and the hosting camp harmless for all such fees and costs.

    By signing this document, I acknowledge that if anyone is hurt or property damaged during my child’s participation in these activities, I and/or my child may be found by a court of law to have waived any right to maintain a lawsuit against Tower of Faith Youth Department or the hosting camp based on any claim which has been released herein. I have had sufficient opportunity to read this entire document. I have read and understood it and agree to be bound by its terms.

  • Are you free from infectious disease or conditions?*
  • Are immunizations up to date?*
  • All fileds are required below.  If nothing applies, please put "NONE" in the box. 

     

  • Counselor Questionnaire

  • First Time Counselor?*
  • Payment Information

  • My Products*

    prevnext( X )
      Payment options Price
      Full Payment $200.00$200.00
      Deposit $100.00$100.00
      Camp Hoodie $35.00$35.00


      Total $0.00$0.00

      Payment Methods

      creditcard
      After submitting the form, you will be redirected to Apple Pay to complete the payment.
      After submitting the form, you will be redirected to Google Pay to complete the payment.
    • You can also pay VIA  

      Zelle Joshua- (424) 217-9469 
      CashApp- $longlivedante
      Venmo- @Joshua_Dante
      If you have any questions feel free to contact Daniella Easley at (754) 777-3876 or Joshua Easley at (424) 217-9469

    • By hitting submit and putting your initials, you agree that you are over the age of 18.  In case of medical emergency or general medical care, I give consent for medical teatment for the aboved named counsleor by authorized personnel.  The camp carries secondary insurance. I authorize FIRE Youth Department to use my camper's picture, testimony, and video in any promotional material(web,print,or media)  Imay recieve any e-mails from the camp.  

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