Staff Registration

FOLLOW THESE 4 EASY STEPS:

 

Step #1

STAFF REGISTRATION

NO FEE

*Background application or RECENT copy of background clearances must accompany application*

Upload Clearances
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To make Registration easier, you may pre-purchase a Canteen Card in $5.00 & $10.00 increments.

Pre-purchased Canteen Cards will be available at registration.

Camp T-Shirts may be purchased for $10.00 each. 

In what capacity would like to serve at Youth Camp?  Please check more than one below:

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If you chose to be a counselor, please select your age group preference:

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Have you been convicted of a felony or misdemeanor, other than a minor traffic violation?

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*Every STAFF form will be reviewed by Pastor Bond for approval.

Thanks for registering!

Step #2

 
STAFF MEDICAL INFORMATION

The following information is necessary in case of medical emergency.

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I give camp nursing staff permission to give my child over the counter medication:

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ARE YOUR IMMUNIZATIONS UP-TO-DATE?

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Last Tetanus Shot (Contact your medical provider for the date)

Are you claiming a personal or religious exemption from immunization?

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Thanks for submitting!

Step #3

 
AGREEMENT TO PARTICIPATE

The proposed activities provided by RevTab Youth Camp require participation in physical exercises which are by their nature, physically demanding.  Many of the activities, including, but not limited to, challenge course activities, soccer, basketball, volleyball, paintball, archery, canoeing, fishing, etc., will or may challenge you, and could cause surges in blood pressure and pulse rates.  It is imperative that you are free from any heart-related or other diseases.  Therefore, all participants must be free of medical or physical conditions which might create undue risks to themselves or any others who depend on them.  If there is any doubt about your ability to safely participate in this experience, you should receive a physical examination.  If you have any of the above inquired conditions, it is solely your responsibility to receive the necessary approval from the appropriate health care providers for your participation in all physical activities.   If more information is needed regarding such activities, please contact RevTab Youth Camp, at (570) 538-2000 or email us at revtab09@ windstream.net.

ASSUMPTION OF RISK AND RELEASE OF LIABILITY

PLEASE READ BEFORE SIGNING

 

I (we) acknowledge that during the session that the applicant has requested to participate in, certain risks and danger may occur.  I (we) recognize that such risks and danger may include loss or damage to personal property, physical injury, or fatality due to accident.  I am healthy (both physically and emotionally) and capable of participating in this session.  The health history is correct as far as I know, and the person herein described has permission to engage in all prescribed camp activities except as noted.  I fully authorize the camp’s medical personnel to treat me/my child.  I, individually and on behalf of the minor, do hereby release, RevTab Youth Camp and its employees from any and all liability.  Including, but not limited to, the negligence of RevTab Youth Camp, and its employees.  I also understand that my child’s participation in the RevTab Youth Camp session is entirely voluntary. I enter into this session and take full decision to participate or not participate and agree to follow all safety instructions. I agree that being allowed to participate in RevTab Youth Camp is sufficient consideration to support this agreement to participate.

Thanks for submitting!

Step #4

Step #4