Applications Closed for Winter & Fall Retreats

Release Statement

I hereby submit my child’s application to participate in programs run by The Youth Ministry of the Diocese of Philadelphia and Eastern Pennsylvania (Orthodox Church in America). My child agrees to abide by all program rules and regulations set forth by the Program Directors at the risk of being removed from the camp program without refund. I understand that The Youth Ministry of the Diocese of Eastern Pennsylvania cannot be responsible for loss of valuables or damage to personal property. I recognize that certain risks and dangers exist during participation in a Youth Ministry of the Diocese of Eastern Pennsylvania Program, including injury or fatality due to accident or illness. I understand that The Youth Ministry of the Diocese of Eastern Pennsylvania, its insurers, its directors, and its staff shall assume no responsibility or liability for accidents, illness, or loss or damage of personal property, and I acknowledge and do hereby assume all risks in connection with this activity. I hereby hold The Youth Ministry of the Diocese of Eastern Pennsylvania, its insurers, and/or its agents harmless from any and all liability, action, claims, and damage of every kind and nature whatsoever, associated with my child’s participation at the camp.

I hereby consent and authorize The Youth Ministry of the Diocese of Eastern Pennsylvania Program Directors and Camp Medical Officers/Nurses to provide or authorize treatment, whether on or off of camp property, for any first aid, whether routine or emergency, including but not limited to injury, illness, or choking. I consent and authorize the Youth Program Directors and Camp/Program Medical Officers/Nurses or other duly certified adult to provide or authorize treatment, including cardiopulmonary resuscitation (CPR) in the event of a water sport accident or other need. If I cannot be reached at the time of my child’s emergency or other medical need, I hereby appoint, Authorize, and Constitute the Youth Program Directors and Camp Medical Officers/Nurses or other authorized staff member to act on my behalf to authorize and consent to medical treatment for my child as named, including authorizing emergency surgery. In case of need, I authorize any family or specialist physician, dentist, or other licensed health care professional and also any licensed health care facility to provide any and all necessary treatment to my child. The below consent and authorization includes any routine, emergency, inpatient and outpatient care. Any health care professional or health care facility is authorized to accept and rely on The Youth Ministry of the Diocese of Eastern Pennsylvania's Staff representation in the event that I cannot be reached. The original of this form shall be displayed to the health care provider by will remain in the custody of the Program Directors and Program/Camp Medical Staff.

I also hereby give The Youth Ministry of the Diocese of Eastern Pennsylvania my consent that any photographs, films, audio and visual recordings for which my child posed may be used by them and their assigns or successors, in whatever way they may desire, including newspaper, audiovisual productions, television, radio, internet and other public relations purposes.

I acknowledge that any cancellations made less than two weeks before the event are non-refundable

I certify that statements provided on this application are true and complete, and any misrepresentation or omission may be grounds for rejections or for expulsion from the camp program. This statement authorizes The Youth Ministry of the Diocese of Eastern Pennsylvania to contact any individual listed in this application.