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Event Registration
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Harvey Cedars 2022 Counselor Registration on Monday, June 20, 2022
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Price:
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*
Attendee's First Name:
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Attendee's Last Name:
*
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Attendee's Phone Number:
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The number of counselors we take is dependent on student registration. Due to this, your registration does not guarantee your spot. If you register and then do not need to attend, you will be fully reimbursed.
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Harvey Cedars Counselors 2022
Qty
Price
JH Harvey Cedars Counselor 2022
1
95.00
SH Harvey Cedars Counselor 2022
1
100.00
Senior Trip Add-on Option
Qty
Price
Senior Trip Add-on Option (12th grade leaders)
1
100.00
*
Preferred T-shirt Size
-- Select --
Adult Small
Adult Medium
Adult Large
Adult X-Large
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Emergency Contact Person AND Cell Phone Number
Please list any specific dietary requirements that you would like us to communicate to the Harvey Cedars food service staff. (This does not guarantee that all requests can be accommodated. If and when possible, you should plan to bring supplemental food items along if they will be needed. Separate refrigeration is available and accessible in the dining hall for your use for this purpose.)
Information we need to consider (arriving late, not traveling with the group, planning to drive your own vehicle, able to drive a church vehicle, etc)
Required on File Information
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Have you ever been convicted of a crime (Other than a minor traffic violation)?
Yes
No
If yes, please explain
Please supply the names, positions, and email addresses or cell numbers of two qualified people who would recommend you for the role of camp counselor.
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References:
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When was the date of your last TB test?
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Please read the following two statements and type your full name acknowledging that you read and agree to the statement.
Child Protection: The counselor is responsible to watch for any visible signs of child abuse and to immediately report them to the Youth Pastor and Youth Week and Camp Directors and such allegations must be reported to the NJ Department of Children and Families’ child abuse hotline 1-877-652-2873 (1-877-NJAbuse) Do NOT discuss the matter with anyone else. [Additionally, for non-NJ groups, also follow your state’s reporting guidelines.]
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Camper Discipline: Camper discipline shall not include physical exercise, meal deprivation, sleep deprivation, corporal or peer group punishment or unsupervised isolation. Approved camper discipline allows for exclusion from camp activities or point subtraction from teams.
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I have read the following documents:
HCBC Youth Regulations Sheet
HCBC Counselor Info Packet
Yes
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I acknowledge that participation in summer camp 2022 at Harvey Cedars Bible Conference involves risk to the participant, and may result in various types of injury including but not limited to the following: sickness, exposure to infectious/ communicable disease, bodily injury, death, emotional injury, personal injury, property damage, and financial damage. In consideration for the opportunity to participate in the activity described above (the “activity”), the participant acknowledges and accepts the risks of injury associated with participation in and transportation to and from the activity. The participant accepts personal financial responsibility for any injury or other loss sustained during the activity or during transportation to and from the activity, as well as for any medical treatment rendered to the participant that is authorized by the sponsor or its agents, employees, volunteers, or any other representatives (collectively referred to as the “activity sponsor”). Further, the participant releases and promises to indemnify, defend, and hold harmless the activity sponsor for any injury arising directly or indirectly out of the described activity or transportation to and from the activity, whether such injury arises out of the activity sponsor, the participant, or otherwise. If a dispute over this agreement or any claim for damages arises, the participant agrees to resolve the matter through a mutually agreeable alternative dispute process. If the participant and the activity sponsor cannot agree upon such a process, the dispute will be submitted to a three-member arbitration panel for resolution in accordance with the rules of the American Arbitration Association.
I also give permission to WSEFC to use photographs and/or video taken during the event for promotional purposes such as the web site, brochures, etc.
I, the undersigned, agree to all of the above statements and my full printed name below represents my electronic signature.
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