Discounted Registration

Camp Registration 2.0

Youth Camp Registration Form (ID #7438)

Step 1 of 7

Waivers

ICJC Liability Waiver

In consideration of the Islamic Center of Johnson County allowing you to participate in the above activity, I, the undersigned, do hereby release, forever discharge, and agree to hold harmless the Islamic Center of Johnson County (ICJC) their employees, directors, volunteers, board of directors, agents from any and all liability, claims or demands for accidental personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the Participant while involved in the conference/ event activities. I, the parent or legal guardian of this Participant hereby grant my permission for the Participant to participate fully in all Conference/ event activities.

I, on behalf of my minor Participant, hereby assume all risk of accidental personal injury, sickness, death, damage and expense as a result of participation in recreation and work activities involved in this conference/ event.

The undersigned hereby agrees to hold harmless and indemnify the Islamic Center of Johnson County (ICJC) for any liability sustained by said organizations as the result of the negligent, willful or intentional acts of said Participant, including expenses incurred.

Signature

Clear Signature

Safety and Pick up Procedures During Camp

At Camp, the safety, well-being, and positive experience of every participant are our top priorities. In order to ensure the smooth operation of our camp program and maintain a secure environment for all attendees, we have implemented the following policy regarding early pickup of campers by parents or guardians:

Policy Statement:

Parents or guardians are not permitted to pick up their children early from Camp except in cases of emergency or unavoidable circumstances approved by camp administration.

Rationale:

Safety and Security: Camp operates under a structured schedule with planned activities and supervision by trained staff members. Allowing early pickups disrupts the supervision and security protocols put in place to ensure the safety of our campers.

Disruption to Programming: Early pickups disrupt the flow of camp activities and may detract from the overall experience for both the departing camper and their fellow participants. It can also impact the planning and execution of scheduled activities and group dynamics.

Impact on Experience: As highlighted above, campers leaving camp early often miss out on key program components, impacting their overall experience and the spirit of camp.

Accountability: By adhering to a consistent policy on early pickups, we maintain accountability for the whereabouts of all campers at all times. This helps ensure that campers remain within the designated camp area and under the supervision of authorized staff members.

Exceptions:

Emergency Situations: In cases of emergency, such as illness, injury, or family emergencies, parents or guardians may request an early pickup. Camp administration will assess each situation on a case-by-case basis and grant approval if deemed necessary.

Pre-Approved Absences: If a camper has a pre-approved absence from camp activities, such as a medical appointment or family event, arrangements must be made in advance with camp administration. Early pickups for pre-approved absences will be coordinated to minimize disruption to the camp program.

Procedure for Early Pickup:

Contact Camp Administration: Parents or guardians requesting an early pickup must contact camp administration in advance to explain the reason for the request and obtain approval.

Sign-Out Process: Upon arrival for early pickup, parents or guardians must sign out their child at the designated check-in area. Camp staff will verify the identity of the individual picking up the camper and record the time of departure.

Notification of Staff: Camp staff members will be notified of any early pickups and instructed to assist in facilitating the departure of the camper while ensuring that all necessary belongings are collected.

Enforcement:

Failure to adhere to the Camp Early Pickup Policy may result in disciplinary action, including loss of camp privileges. Camp administration reserves the right to enforce this policy in the best interest of the camp community

BY SIGNING BELOW I CERTIFY THAT I HAVE READ THIS DOCUMENT AND FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL.

Signature

Clear Signature

Event Code of Conduct Waiver

ICJC is dedicated to providing a positive and harassment-free event experience for everyone. We do not tolerate harassment of event participants in any form, nor do we tolerate any behavior un-Islamic or that would reasonably lead to another event participant being made to feel unsafe. All communication, wardrobe, and background images (if applicable) should be appropriate for a professional audience including people of many different backgrounds.

By submitting this form, I, the parent/ guardian of the youth participating in the ICJC Event understand that my youth is expected to agree and abide by all the rules below. I assume full responsibility for any damage to persons and/or property caused by my child. I also give full permission and consent to ICJC Staff or adult volunteers to search all baggage and persons if we suspect any breaking of rules or harmful paraphernalia. Further, I agree to be responsible for all expenses incurred in sending him/her home if my youth refuses to follow the rules below or other rules set at ICJC.

Islamically appropriate dress shall be observed at all times. For brothers this means loose clothing covering between the navel and knees inclusive (in other words, even when kneeling down your knees should be covered), and for sisters to wear loose clothing, including a head scarf that covers all of the hair, exposing only the face and hands.
Islamic behavior is to be observed at all times, which includes polite speech, respecting elders, listening to those in authority, respecting the other participants.
No inappropriate intermingling between the genders*.
All youth must stay on the ICJC property at all times, and within the areas of the property that are designated for our use.
No pranks.
No fighting.
No weapons of any sort.
No drugs of any sort, including tobacco products.
No electronic games (eg. PSPs)
No music players of any kind
No cell phones!! (Cell phones will be kept by counselors and limited use during recreation time will be allowed to call home.)
Any participant found responsible for vandalizing property or causing damage will incur a charge following the camp. An invoice will be sent to their parents accordingly.

Examples of encouraged behavior that contributes to a positive environment include:

Using welcoming and inclusive language
Being respectful of differing viewpoints and experiences
Gracefully accepting constructive criticism
Focusing on what is best for everyone at the event
Showing empathy towards other participants
Unacceptable behavior includes:
The use of bad language, or inappropriate gender interaction.
Trolling, insulting or derogatory comments, personal or political attacks, or sustained disruption of talks or other events
Deliberate intimidation, stalking, following, or harassing photography or recording
Harassment of any kind, even in a joking or ironic manner
Other conduct which could reasonably be considered inappropriate in a professional setting

Be kind to others. Do not insult or put down other attendees. Behave professionally. Remember that harassment and, racist, or exclusionary jokes are not appropriate at this event.

Each event guest is entirely responsible for their own actions.

Thank you for helping to make this a welcoming, friendly space for all.

BY SIGNING BELOW I CERTIFY THAT I HAVE READ THIS DOCUMENT AND FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL.

Signature

Clear Signature

Policies, Waivers, Release Forms and Guidelines

As a parent/guardian, I understand that participation in Camps, organized by Islamic Center of Johnson County (ICJC), involves a certain degree of risk. I have carefully considered the risk involved and have given my son/daughter my consent to participate in the Camp. I also agree to pay the CAMP registration fees. This health history is correct and complete as far as I know. The person(s) herein named have permission to engage in all CAMP activities except as noted. I allow to take pictures of my child and use them for all publicity related purposes.

By submitting this form I give the permission to ICJC to provide, seek, and consent to routine health care, administration of prescribed medications (noted above), and emergency treatment for my child as may be necessary, including, but not limited to x-rays, routine tests and treatment, and/or hospitalization. I also give permission for the ICJC to arrange related transportation.

I agree to the release of any records necessary for treatment, referral, billing or insurance purposes.

It is my intention that ICJC be treated as acting in loco parentis if the person herein named is a minor. Further, it is my intention that the appropriate representatives of ICJC be treated as "personal representatives" for the purposes of disclosing protected health information pursuant to the privacy regulations promulgated pursuant to the Health Insurance Potability and Accountability Act of 1996. I hereby agree (pursuant to 45 CFR 164.510(b)) to the disclosure to ICJC representatives of the protected health information of the person herein described, as necessary: (i) to provide relevant information to the ICJC representatives related to the person's ability to participate in ICJC activities; and (ii) in the case of minors, to provide relevant information to the ICJC representatives to keep me informed of my child's health status.

In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by ICJC to secure and administer treatment, including hospitalization, for the person named above.

ICJC Transportation Waiver

For all campers, counselors, organizers, youth and adults, from here forward referred to as "participants", who will be getting to and from camp via Flights, Trains, or Busses, where such camper is in need of ICJC and its adults, counselors, advisors and staff, to provide transportation to and from airports, train stations and bus stations, ICJC and its adults, counselors, advisors and staff, will make every effort to pick up and/or drop off participants, in as best a timely manner as possible within the parameters of its abilites and resources. However, ICJC will not be held responsible, financially or otherwise, for any participants missing flights, trains or busses. This transportation is made possible through volunteers and tight schedules and ICJC can not guarantee situations beyond their control. No parent or guardian of a participant or a participant themselves will hold ICJC responsible financially, or otherwise for any missed methods of transportation and delays in pick ups. ICJC assume no responsibility related to costs, sickness, injury, or death while campers are in transit during any of the above mentioned transports.

Media Waiver

I understand that at this event or related activities, I may be photographed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by the event holders, producers, sponsors, organizers, and assigns.

Documentary Participation Waiver/Release Form (if you selected yes above to participating in the ICJC Documentary)

I, the undersigned, hereby grant permission to the Islamic Center of Johnson County, the Producer of The Documentary, following the lives of a few youth before camp, at camp, and after camp, to be later named, the right to use my full name, biography, video image, likeness, and audio collected during this production.

I also grant permission to record my image, voice, and performance, and transfer to the filmmaker/photographer all rights, title, and interest in the interview and video documentary. This includes, without limitation, the literary rights and the copyright of my picture, photograph, silhouette, other reproductions of my physical likeness and my voice collected in connection with the unlimited distribution, advertising, promotion, exhibition, and use throughout the world and in perpetuity and on whatever media is known or hereafter devised.

I agree that I will not assert, maintain or consent to others bringing any claim, action, suit or demand of any kind or nature whatsoever against the Producer including but not limited to, those grounded upon invasion of privacy, rights or publicity or other civil rights, or for any other reason in connection with the authorized use of my physical likeness and sound in The Documentary as herein provided. I hereby release the Producer, its directors, officers, successors and assigns from and against any and all claims, liability, demands, actions, causes of action(s), costs, expenses and damages whatsoever, at law or in equity, known or unknown, anticipated or unanticipated, which I ever had, now have, or may, shall or hereafter have by reason, matter, cause or thing arising out of the rights granted to the Producer herein.

The Producer, in return, agrees to retain the integrity of the interviewee's image and voice, neither misrepresenting the interviewee's words nor taking them out of context. I attest that I have voluntarily agreed to be interviewed and that this document contains the entire and complete agreement concerning the use and preservation of my interview.

I, the undersigned, shall not be given any fees for the services provided for this production.

I understand that participation in the Camp, organized by Islamic Center of Johnson County (ICJC), involves a certain degree of risk. I have carefully considered the risk involved and have given my son/daughter permission to participate in the Camp and I release ICJC and all of its employees, officers, volunteers from any liablity that could result from my youth's participation in the ICJC Camp.

BY SIGNING BELOW I CERTIFY THAT I HAVE READ THIS DOCUMENT AND FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL.

Signature

Clear Signature

Child Information

Parent/Guardian Information

Emergency Contact

Health Info Page 2

Health Info Page 2

Logistics

Waivers

ICJC Liability Waiver

Safety and Pick up Procedures During Camp

Policy Statement:

Parents or guardians are not permitted to pick up their children early from Camp except in cases of emergency or unavoidable circumstances approved by camp administration.

Rationale:

Safety and Security: Camp operates under a structured schedule with planned activities and supervision by trained staff members. Allowing early pickups disrupts the supervision and security protocols put in place to ensure the safety of our campers.

Disruption to Programming: Early pickups disrupt the flow of camp activities and may detract from the overall experience for both the departing camper and their fellow participants. It can also impact the planning and execution of scheduled activities and group dynamics.

Impact on Experience: As highlighted above, campers leaving camp early often miss out on key program components, impacting their overall experience and the spirit of camp.

Accountability: By adhering to a consistent policy on early pickups, we maintain accountability for the whereabouts of all campers at all times. This helps ensure that campers remain within the designated camp area and under the supervision of authorized staff members.

Exceptions:

Emergency Situations: In cases of emergency, such as illness, injury, or family emergencies, parents or guardians may request an early pickup. Camp administration will assess each situation on a case-by-case basis and grant approval if deemed necessary.

Pre-Approved Absences: If a camper has a pre-approved absence from camp activities, such as a medical appointment or family event, arrangements must be made in advance with camp administration. Early pickups for pre-approved absences will be coordinated to minimize disruption to the camp program.

Procedure for Early Pickup:

Contact Camp Administration: Parents or guardians requesting an early pickup must contact camp administration in advance to explain the reason for the request and obtain approval.

Sign-Out Process: Upon arrival for early pickup, parents or guardians must sign out their child at the designated check-in area. Camp staff will verify the identity of the individual picking up the camper and record the time of departure.

Notification of Staff: Camp staff members will be notified of any early pickups and instructed to assist in facilitating the departure of the camper while ensuring that all necessary belongings are collected.

Enforcement:

Failure to adhere to the Camp Early Pickup Policy may result in disciplinary action, including loss of camp privileges. Camp administration reserves the right to enforce this policy in the best interest of the camp community

BY SIGNING BELOW I CERTIFY THAT I HAVE READ THIS DOCUMENT AND FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL.

Event Code of Conduct Waiver

Be kind to others. Do not insult or put down other attendees. Behave professionally. Remember that harassment and, racist, or exclusionary jokes are not appropriate at this event.

Each event guest is entirely responsible for their own actions.

Thank you for helping to make this a welcoming, friendly space for all.

BY SIGNING BELOW I CERTIFY THAT I HAVE READ THIS DOCUMENT AND FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL.

Policies, Waivers, Release Forms and Guidelines

I agree to the release of any records necessary for treatment, referral, billing or insurance purposes.

In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by ICJC to secure and administer treatment, including hospitalization, for the person named above.

ICJC Transportation Waiver

Media Waiver

I understand that at this event or related activities, I may be photographed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by the event holders, producers, sponsors, organizers, and assigns.

Documentary Participation Waiver/Release Form (if you selected yes above to participating in the ICJC Documentary)

I, the undersigned, shall not be given any fees for the services provided for this production.

Snackbar Tab

Would you like to start a snack bar tab for your campers? At camp, we offer a variety of snacks for purchase and this option would allow your child to buy things without the hassle of carrying cash (and losing it).

Indicate below the amount you would like to set up per camper:

Support ICJC/Payment