REGISTRATION CHECKLIST June 17-21 Northern Virginia Online Registration: Register the number of students and adults that will come to camp. A $300 non-refundable deposit is due per church to cover ministry expenses. Registration Rates: Until April 19 Early Registration $90 April 20 May 17 Registration $110 Submit forms: All forms must be in the SBCV office by 9:00am on May 17. Church Registration Church Waiver/Release Rooming List Student Registrations (1 per student, notarized) Adult Registrations (1 per adult, notarized) Forms can be submitted 1 of 3 ways: Email to: Mindy McCord at mmccord@sbcv.org Fax to: Fusion Mission Camp at (804) 270-1834 By mail: Attn Fusion Mission Camp 4956 Dominion Blvd Glen Allen, VA 23060 Camp Balance: Final balance is due by June 17 at Fusion. Payments can be made in the form of a check or by credit card. If paying via check, please make the check payable to SBC of Virginia. Checks can also be mailed to the SBCV prior to camp. For more information, visit our website, send an email or give us a call! Web: sbcv.org/fusion Email: nextgen@sbcv.org Call: (804) 270-1848 Updated 09-2018
REGISTRATION AND REFUND POLICIES In preparing for camp, the SBCV obligates itself financially by purchasing supplies, reserving facilities and hiring staffers. We base our purchases, reservations, and hired staffers on actual number of registrations, with some allowance for fluctuations. We understand that circumstance arise that may prevent a student from attending camp. In order to reduce as much as possible the costs associated with cancelled reservations we require a minimal deposit and have attempted to leave registration open as long as possible. Campers should carefully consider their ability to attend camp before registering. The following policies will govern registration, deadlines, and refunds. Fusion Mission Camp is available to rising 6 th graders thru recent high school graduates. Churches must bring 1 adult for every 10 students of each gender. A $300 per church, non-refundable deposit is required to hold your desired number of spots. Churches may increase or decrease the number of spaces reserved for camp until May 17. Churches will be charged the registration rate based upon the time frame that they register campers. For example: If a church registers 10 campers during Early Registration (by April 19), then adds three during Registration (April 20-May 17), the three that are added later will pay the higher price. After May 17, all reserved spots must be paid in full by June 17. Additions after May 17 will be considered based upon availability at the $110 rate. Any church group that submits paperwork after the deadline of May 17 will incur a $75 late fee. Please do not arrive at camp with non-registered campers or those that have not completed the necessary forms. Churches must be able to provide transportation for their groups to and from the mission sites throughout the week. Church Group time is an essential part of the camp experience. They meet daily (Tuesday-Thursday) to work through three provided Bible studies. Bible study prep tools will be provided to Church Group leaders shortly after the registration. Updated 09-2018
CHURCH REGISTRATION FORM CHURCH NAME: PHONE: FAX: MAILING ADDRESS: YOUTH LEADER: WORK PHONE: CITY, STATE, ZIP: EMAIL: CELL PHONE: I learned of this event. Camp Brochure Proclaimer Word of Mouth Website Other: MISSION SITE PREFERENCES: Pre-Evangelism: Projects designed to minister in communities with the purpose of building relationships, earning "the right to be heard". The likelihood of an evangelistic encounter is typically low. This type of project bolsters the reputation of the sponsor church in the community, and builds in-roads for future opportunities to share Christ. Examples include painting, yard work at schools and community centers, clean-up and prayer walking. Relational Evangelism: People-oriented projects with possibility of spiritual conversations. These type of projects meet a need or provide a service directly to people. Examples include attractional events like block parties, VBS, gas buy-down and servanthood evangelism events like a free car wash, free yard service, etc. Intentional Evangelism: Projects that are confrontational, direct and evangelistically focused. Activieis oriented around a verbal presentation of the gospel to individuals or groups. Examples include street witnessing, public skits, testimonies and public performances with a gospel message. PARTICIPANTS: Students Adults T-SHIRT TOTAL: Youth L Small Medium Large X-Large 2XL 3XL Please note that t-shirt orders will be placed based upon the numbers listed above. FOOD ALLERGIES: Please list any food allergies that the volunteers preparing breakfast and lunch need to be aware of: Updated 09-2018
CHURCH WAIVER & RELEASE FORM AGREEEMENT TO WAIVE, RELEASE, INDEMNIFY AND HOLD HARMLESS SOUTHERN BAPTIST CONSERVATIVES OF VIRGINIA FOR ANY LIABILITY CAUSED BY ANY COUNSELOR OR CAMPER SENT BY CHURCH TO CAMP WHEREAS, CHURCH (hereinafter Church) represents and warrants that it has conducted adequate background applications, checks and training on all youth workers and counselors that it sends to accompany the children and youth the Church sends to Southern Baptist Conservatives of Virginia (hereinafter SBCV) camps and programs; and, WHEREAS, said CHURCH represents and warrants that it has adequate child protection and general liability insurance to cover all accidents and incidents and has had each parent and guardian of every child, as well as all chaperones and counselors, sign a waiver and release of all liability against Southern Baptist Conservatives of Virginia which includes a Christian Conciliation provision to resolve any and all disputes according to Biblical principles as outlined at www.hispeace.org; NOW, THEREFORE, IN CONSIDERATION of the above promises and warranties, said church and its proposed attendees are permitted to participate at said camp and in said program under the following conditions: 1. Waiver and Release: In consideration for the obligations of both parties set forth in this Agreement, the Church, solely and on behalf of each of its respective officers, directors, employees, members and assigns, hereby fully and forever waive and release SBCV and its respective agencies, officers, directors, employees, agents, parent and subsidiary corporations, predecessor and successor corporations and assigns, of and from any claim, duty, obligation or cause of action relating to any matters of any kind, whether presently known or unknown, suspected or unsuspected, that any of them may possess arising from any omissions, acts or facts that have occurred or will occur in relation to SBCV camp or program. 2. Indemnity and Hold Harmless. Church hereby agrees to defend, pay, indemnify and save free and harmless Southern Baptist Conservatives of Virginia, its agencies, employees and agents from and against any and all claims, demands, fines, suits, actions, proceedings, orders, decrees and judgments of any kind or nature by or in favor of anyone whomsoever and from and against any and all costs and expenses, including attorneys' fees, resulting from or in connection with loss of life, bodily or personal injury or property damage arising, directly or indirectly, out of or from or on account of any occurrence in, upon, at or from the Camp or occasioned wholly or in part through the use and occupancy of the Camp or any improvements therein or appurtenances thereto, or by any act or omission of Church or SBCV, any agency or program of SBCV, or their respective employees, agents, contractors or invitees in, upon, at or from the Camp from the time they leave said church to attend camp until they return to said church from Camp. 3. Christian Mediation and Arbitration: The Church and SBCV (hereinafter Parties) shall attempt to settle all disputes arising in connection with this Waiver, Release and Indemnification through good faith consultation. In the event no agreement can be reached on such dispute within fifteen (15) days after notification in writing by either Party to the other concerning such dispute, the dispute shall be settled by binding arbitration to be conducted in Loudoun County, Virginia by an arbitrator with the Institute for Christian Conciliation ( ICC )(ICC Rules of Procedure may be located at www.hispeace.org) to be mutually agreed upon, or if no agreement then by a judge or arbitrator selected and appointed by the ICC under ICC rules. The arbitration decision shall be final, conclusive and binding on both Parties and any arbitration award or decision may be entered in any court having jurisdiction. The Parties agree that the prevailing party in any arbitration shall be entitled to injunctive relief in any court of competent jurisdiction to enforce the arbitration
award. The Parties further agree that the prevailing Party in any such proceeding shall be awarded reasonable attorneys' fees and costs. 4. Voluntary Execution of Agreement: This Agreement is executed voluntarily and without any duress or undue influence on the part or behalf of the Church with the full intent of releasing all claims by the Church and its camp participants and indemnifying SBCV for any such claims by third parties. The Parties acknowledge that: (a) Each has read this Agreement; and (b) Each have been represented in the preparation, negotiation, and execution of this Agreement by legal counsel of their own choice or have voluntarily declined to seek such counsel; and (c) Each understand the terms and consequences of this Agreement and of the releases it contains; and (d) Each is fully aware of the legal and binding effect of this Release, Waiver, Indemnification and Hold Harmless Agreement. 5. No Oral Modification: This Agreement may only be amended in writing and signed by the parties. 6. Governing Law: This Agreement shall be governed by the laws of the Commonwealth of Virginia, without regard to its conflicts of law provisions. 7. Counterparts: This Agreement may be executed in counterparts, and each counterpart shall have the same force and effect as an original and shall constitute an effective, binding agreement on the part of each of the undersigned party. 8. Authority: The Church represents and warrants that the undersigned has the authority to act on behalf of the Church and to bind the Church and all who may claim through it to the terms and conditions of this Agreement. IN WITNESS WHEREOF, the Parties have executed this WAIVER, RELEASE, INDEMNIFICATION AND HOLD HARMLESS Agreement on the respective dates set forth. CHURCH: Youth Leader: Title: Date: Notary Acknowledgement: City/County of, Commonwealth of Virginia subscribed and sworn to before me, in my presence this day of, 201 by Notary Public. My commission expires:.
ROOMING LIST CHURCH NAME: CHURCH CITY: YOUTH LEADER: SPECIAL NEEDS (wheelchair accessible, etc): MALE ADULT? FEMALE ADULT? Updated 01-2017
STUDENT REGISTRATION & COVENANT MEDICAL RELEASE OF LIABILITY NAME: MALE FEMALE BIRTHDATE: GRADE ENTERING IN FALL: GRADUATED T-SHIRT (Youth Large Adult XXL available): CHURCH: CHURCH CITY: YOUTH LEADER: EMERGENCY CONTACT: RELATIONSHIP: CELL: EMERGENCY CONTACT: RELATIONSHIP: CELL: INSURANCE COVERAGE: YES NO SUBSCRIBER NAME: INSURANCE COMPANY: POLICY #: FAMILY PHYSICIAN: Immunizations Current? : YES NO PHONE: PAST MEDICAL HISTORY Does student have special needs (wheelchair accessibility, food allergies, etc)? Drug allergies? Other allergies? Medications currently taking: STUDENT COVENANT: I understand the guidelines of the Fusion Mission Camp Covenant are necessary to maximize the spiritual opportunities of the week and to ensure a quality, fun time for myself and other campers. Having read and prayed through them, I willingly commit myself to abide by them. Students that violate rules can be asked to leave camp, if necessary, at the student s expense. Major discipline issues/violations are to be reported to the Camp Director or Camp Assistant. Student Signature: Date: PARENTAL CONSENT: I hereby give consent to any necessary medical treatment that may be given by medical personnel in case of accident or injury. By my signature below, I understand that expenses for medical care will be my responsibility. I hereby agree not to hold the SBC of Virginia responsible or liable for any injury that may occur while attending a SBCV Fusion Mission Camp. I also understand and will allow photos and videos of my child to be taken while at this event to be used for any SBCV promotions and publications. Parent Signature: NOTARY ACKNOWLEDGEMENT: City/County of, Commonwealth of Virginia subscribed and sworn to before me, in my presence this day of, 201 by Notary Public. My commission expires:. Date: Updated 01-2017
ADULT LEADER REGISTRATION & COVENANT MEDICAL RELEASE OF LIABILITY NAME: MALE FEMALE BIRTHDATE: T-SHIRT (Youth Large XXL available): Youth Large Small Medium Large X-Large 2XL 3XL CHURCH: CHURCH CITY: YOUTH LEADER: EMERGENCY CONTACT: RELATIONSHIP: CELL: EMERGENCY CONTACT: RELATIONSHIP: CELL: INSURANCE COVERAGE: YES NO SUBSCRIBER NAME: INSURANCE COMPANY: POLICY #: FAMILY PHYSICIAN: PHONE: Immunizations Current? YES NO PAST MEDICAL HISTORY Do you have special needs (wheelchair accessibility, food allergies, etc)? Drug allergies? Other allergies? Medications currently taking: COVENANT: I understand that the guidelines of Fusion Mission Camp are necessary to maximize the spiritual opportunities of the week and to ensure a quality, fun time for all campers. Having read and prayer through them, I willingly commit myself to abide by them. Campers who violate the rules could be asked to leave camp, if necessary, at the camper s expense. I hereby give consent to any necessary medical treatment that may be given by medical personnel in case of accident or illness. By my signature below, I understand that expenses for medical care will be my responsibility. I hereby agree not to hold the SBC of Virginia responsible or liable for any injury or accident that may occur while attending a SBCV Fusion Mission Camp. I also understand and will allow photos and videos of myself to be taken while at this event to be used for any SBCV promotions and publications. Signature: Date: NOTARY ACKNOWLEDGEMENT: City/County of, Commonwealth of Virginia subscribed and sworn to before me, in my presence this day of, 201 by Notary Public. My commission expires:. Updated 01-2017