Event Registration

You are registering for

Camp SHiNE 2018
Circle C Ranch

10451 Ashcraft Rd, Delevan, NY 14042

October 5, 2018 - October 7, 20185:00pm - 2:30pm

Participant Information

Emergency Contact Information

Add-ons

Legal Forms

MEDICAL AUTHORIZATION/CONSENT TO TREAT MINOR

It is my understanding that The Chapel at CrossPoint, its staff, volunteers, and/or representatives will immediately attempt to contact me in case of a medical emergency involving my child. If the above mentioned individuals cannot reach me, I hereby authorize and give my consent to any x-ray, anesthetic, medical, surgical, or dental diagnosis or treatment that may be deemed necessary for my child.

Further, in the event I cannot be reached, I give permission to the aforementioned representatives of The Chapel at CrossPoint (or, in the event that such representative are not present) the attending physician, to make decisions regarding the best course of treatment for my child. I recognize that any healthcare provider and/or practitioner will take all reasonable safety precautions during the pendency of their care. Such vested authority shall terminate when I am able to be reached and acquainted with my child’s medical situation.

As parent (or legal guardian) I recognize that I am responsible for the health care decisions for my child and agree that my insurance plan is the primary plan utilized to pay for the dental, medical, and/or hospital care or treatment given to my child. Any insurance policy retained by The Chapel at CrossPoint or other organization sponsoring the event referenced in the above HOLD HARMLESS AGREEMENT shall be used as secondary coverage.

** PLEASE NOTE ANY ALLERGIES OR PERTINENT HEALTH INFORMATION APPLICABLE TO THE PARTICIPANT**

Medications (with dosage), Medical Conditions, Recent surgeries, Dietary restrictions, Any other relevant information
If Participant is 17 years or younger, this must be signed by Parent/Guardian

Additional Information

Registration Summary

  • Participant 1 Total $119.00
Total Cost $119

Questions about this event?
Contact Erik Arneth at earneth@thechapel.com or 716.631.2636 x219

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Childcare Information

King's World offers a safe, loving, and educational environment for your child while you are serving or being equipped to live out your faith in Christ. Childcare is offered in conjunction with our daytime and evening programs (mornings on Tuesday and Thursday and evenings on Monday, Wednesday and Thursday). If you need assistance with childcare, it is necessary for you to register your child(ren) in advance for all ministry activities at The Chapel as pre-registration allows us to schedule adequate supervision.

What ages are eligible for childcare?
Morning childcare is for children from birth to pre-school (up to age 5 that are not in or eligible for kindergarten). Evening childcare is available for children from birth to 12 years of age. Check with the Childcare Coordinator to know the specifics for each ministry activity you are enrolling in.

Is there a cost for childcare?
In order to continue to provide quality childcare, we have included a nominal fee to offset the costs that are accrued throughout the year for supplies and building usage. The cost varies per ministry, and the cost doubles for two children and triples for three or more children. Be sure to pre-register your children for childcare by registering for your event/bible study and selecting childcare on the form. Any children that are not pre-registered through this website will incur a $3 charge for drop off and will only be admitted if space is available.

Please be aware that childcare at The Chapel is provided by volunteers, so space is not guaranteed (even if registered).

Any questions or concerns may be directed to Mindy Witte, Chapel Childcare Coordinator, at mwitte@thechapel.com or 716.631.2636 x230.