Online Camper Registration Form

St. Vladimir’s Camp & Retreat Center MEDIA RELEASE FORM uses photographs and videos of our campers & staff in a variety of printed and online media, including viewbooks, e-newsletters, the camps’s website, brochures, admissions materials, fundraising efforts, the camp’s official social media outlets, and occasionally with local or national news media. In promoting the camp, we sometimes use campers and staff’ names, images and samples of work. These might include photographs, video/audio recordings, quotations, student writing, and artwork. In all digital communications, campers and staff are, at most, identified only by first name and the first initial of their last name (e.g., John D.). Full names are never used on digital publications, but may be used in print publications when appropriate. Additionally, photographs, video, and/or audio tapes of campers performances and samples of campers work intended for publication or display may be stored in the camps archives and/or library for preservation. This Media Release form requests your consent to use your campers name, image, words, and/or work in camp publications and for the archival purposes outlined above. Campers whose families do not consent will be placed on a “Media Consent Denied” list. This agreement covers only those official Camp publications that are intended for the general public.

We ask that if your send small snacks with your child that they are nut free!

I/we understand all reasonable safety precautions will be taken at all times by St. Vladimir’s Camp & Retreat Center and its agents during camp. I/we understand the possibility of unforeseen hazards and know the inherent possibility of risk. I/we agree not to hold St. Vladimir’s Camp & Retreat Center, its leaders, employees, and/or volunteers liable for damages, losses, disease, or injuries incurred by the subject of this form. I/we agree that my child/we will abide by all the rules and guidelines set forth by St. Vladimir’s Camp & Retreat Center for the safety and good health of the campers, staff and volunteers at camp. I/we also agree that if my child has/we have to return home due to discipline violations, it will be at my/our own expense. I/we agree to indemnify and hold harmless, St. Vladimir’s Camp & Retreat Center, their leaders, employees, and/or volunteers from any expenses, loses , claims, or damages incurred as a result of the acts or omissions of the subject of this form. These registration and health forms may be photocopied for trips off of camp. I/we hereby agree to indemnify and hold harmless the St. Vladimir’s Camp & Retreat Center, their clergy, officers, directors, employees, staff and volunteers from any and all expenses, claims, costs or attorney fees incurred as a result of claims, actions and/or suits brought by me, my child or on my behalf or on my child's behalf or by anyone else as a result of any accident of injury occurring to me or my child.

I give my permission for the registered individual to attend St. Vladimir’s Camp& Retreat Center. I acknowledge their participation in this program is fully voluntary. I specifically assume all risks and hazards associated with the attendee’s participation in the Camp including, but not limited to, the risks associated with communicable diseases such as the COVID-19 virus. I understand that despite the Camp’s best efforts to ensure a safe and healthy environment, the attendee will be associating with staff and other participants and may contract COVID-19, other viruses and illnesses, pests (e.g. bedbugs, lice), through the attendee’s participation in the Camp. I understand that those illnesses and/or pests may subsequently be transmitted from the attendee to me and members of my household. While reasonable and appropriate supervision is provided, participation in camp activities carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injury or illness. I certify that the attendee is in good health, and has no current issues that would make it unsafe for their full participation in camp activities. I understand that camp includes outdoor activities, hikes and walks in the woods with possible exposure to mosquitos, bees, ticks, poison ivy, and slippery and jagged surfaces among other dangers and risks. I also understand that outdoor activities may occur in the hot sun and in the rain. I agree that the attendee will be sent with appropriate attire for camp activities, and I will provide insect repellent and sunscreen for use at camp. I give my permission for staff to assist with the supervision of and/or application of, if necessary, the repellent and sunscreen provided by me. I hereby authorize any medical treatment deemed necessary in the event of any injury or illness. In the event of a medical emergency, 911 will be called and I (parent or guardian) will be responsible for any and all costs of medical treatment. In the event of an emergency, I understand that I will be notified of the situation as soon as possible. I agree to pay any necessary expenses incurred in the medical treatment of the attendee, including, but not limited to all transportation costs to and from a medical facility, and, if necessary, transportation to my home or medical facility of choice. I agree to comply with all health screening protocols prior to arrival at camp. This includes but is not limited to notifying the camp if the attendee develops a fever or illness, tests positive for COVID-19 or another serious illness, or has come into contact with bed bugs or lice. I further acknowledge that the attendee and I are responsible for submitting all relevant health information to St. Vladimir’s Camp& Retreat Center including medication and allergies and that we will cooperate fully with staff to ensure complete compliance with both medication and management of allergies. I understand that the risks associated with camp activities could result in injury and/or death to the attendee. I hereby willingly and voluntarily assume these risks and, knowing them, hereby give the attendee permission to participate. I understand that St. Vladimir’s Camp & Retreat Center is not liable for any injuries or other occurrences due to indoor and outdoor camp activities or related risks, and/or the actions or omissions of St. Vladimir’s Camp & Retreat Center staff, volunteers, and employees. Further, I assume full responsibility for personal injury, accidents or illness, including death, and any expenses as a result of an attendee’s actions or negligence. I also assume responsibility for damage to or loss of personal property as the result of any accident that may occur. To the fullest extent permitted by law, I hereby agree to waive, release, and discharge any and all claims, causes of action, damages, and rights of any kind against St. Vladimir’s Camp & Retreat Center and the Orthodox Church America, its insurers, the Camp’s governing council, and all of their respective employees, staff, representatives, and volunteers (the “Released Parties”) arising from or relating in any way to any damage, injury, trauma, illness, loss, unwanted contact, harassment, disability, dismemberment, or death that may occur to the attendee, me, or my household members—whatever the cause—due to the attendee’s participation in the Camp. This includes, without limitation, any claim arising from the negligence of the Released Parties. I further agree not to sue the Released Parties, and to defend and indemnify the Released Parties for all claims, damages, losses, or expenses, including attorneys’ fees, if a suit is filed concerning an injury, illness, the attendee, myself or my household members resulting from participation in the Camp. I, on behalf of myself and/or the attendee and on behalf of my/his/hers executors, personal representatives, administrators, assignees, heirs and next of kin, agree to release, waive, discharge, and covenant not to sue St. Vladimir’s Camp & Retreat Center, its officers, directors, employees, agents, members, and volunteers, from any and all claims for personal injury (including death), damages, losses, demands, and any other actions or claims whatsoever, which I/he/she may have, including claims based upon the negligence of St. Vladimir’s Camp & Retreat Center, which may, in any way whatsoever, arise out of, be related to or be connected to participation in any and all camp related activities. I acknowledge and understand that I am giving up substantial rights, on behalf of myself and/or my child, including the right to sue. I agree to indemnify and defend St. Vladimir’s Camp & Retreat Center from any and all fault, liabilities, costs, expenses, claims, demands or lawsuits arising out of, related to, or connected with participation at Camp; presence on or use of the buildings, land and the premises, and any and all acts or omissions of myself and/or my child. I agree to indemnify the above-mentioned entities and individuals for any and all expenses and liability they incur as a result of any of attendee’s conduct related to the Camp. I understand that St. Vladimir’s Camp & Retreat Center may, in its sole discretion, dismiss any camp participant for any reason at any time. If such dismissal occurs, I understand that I will not receive a refund of camp fees for unattended days. I expressly agree that this instrument is intended to be as broad and inclusive as permitted by law. If any provision of this instrument is held invalid or otherwise unenforceable, the enforceability of the remaining provisions shall not be impaired thereby. This instrument binds the Attendee, as well as my/his/her executors, personal representatives, administrators, assignees, heirs and next of kin. This instrument shall be governed by the laws of the State of Ohio.