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Camp Hope of East Tennessee
1069 Old Union Rd
Church Hill, TN 37642
www.camphopetn.com

Informed Consent / Release of Liability

This form must be completed in FULL, to include signatures. Campers WILL NOT BE ALLOWED to participate without completion of this form. Separate forms are needed for each camper.

This is a legal binding document. After reading this information and by signing this document, you are...

1) Acknowledging that your child’s/ward’s participation is entirely voluntary

2) Understanding there are risks involved with all activities at Camp Hope of East Tennessee and these risks involve loss of property, personal injury, or even death.

3) Assuming all risks associated with your child’s/ward’s participation in the activities held at Camp Hope of East Tennessee. These activities include, but are not limited to;

Zipline

High Rope Activities

Horseback Riding

River Tubing

Nature Hikes

Various Sports

Team Building

Crafting

Archery

4) Release, waive, hold harmless, discharge, and agree not to sue Camp Hope of East Tennessee, acting by and through Hope Community Church, its staff members, volunteers, director, or any agents acting on behalf of Camp Hope of East Tennessee from any and all liability, claims, actions, demands, expenses, attorney fees, breach of contract actions, breach of statutory duty, or other duty, warranty, strict liability actions, and cause of actions whatsoever, that you might now have or may acquire in the future, arising out of or related to any loss, damage, or injury, including death, that may be sustained by you, your child/ward, any property belonging to you, while training for, traveling to and from, or participating in any activity at Camp Hope of East Tennessee.

5) Stating that your child/ward is healthy enough to participate in camp activities and that you have disclosed all health problems, medications, and allergies to camp staff or group leader.

6) Allowing camp staff or group leader to administer prescription medication as directed, to administer over the counter medications as needed on an individual basis, and in the event of an emergency to consent to emergency treatment to include, but not limited to emergency medical transportation, emergency or hospital treatment deemed appropriate and necessary for safety and protection of child/ward by medical professionals, until you are contacted. Also understanding that you will be responsible for any financial debts incurred during such visit.

7) I also consent for photographs taken of me/my child/ward to be used in marketing/public relations in promotion of Camp Hope of East Tennessee. 

Date: October 22, 2026


The selected Over-the-Counter (OTC) medication may be administered if we have written permission from the Participant’s parent or guardian.

Note: Unless we have parental authorization, we will not administer ANY medications or make OTC

medications available to participants unless necessary as part of general first-aid treatment.



I give permission for the Program staff to administer the following medications to my Participant

consistent with medication directions, if the need arises.

o Sudafed as directed for nasal congestion and allergy relief

o Benadryl for swelling, hives, allergic reaction

o Bug repellant

o Calamine lotion for bug bites and poison ivy

o Hydrocortisone cream for mild skin irritations, poison ivy and insect bites

o Ibuprofen

o Imodium for diarrhea

o Medicated lip ointment for dry, chapped lips, lip blisters or canker sores

o Medicated powder for skin irritation

o Ointments for minor wound care, such as an antiseptic, anti-itch, anti-sting, antibiotic or sunburn

cream

o Pepto Bismol or Mylanta for upset stomach or nausea.

o Rolaids or Tums for acid reflux, heartburn or indigestion

o Sunscreen

o Swimmer’s ear drops

o Throat lozenges and or spray for sore throat

o Tylenol/Acetaminophen

o Visine or another eye drops for minor eye irritation.

o Other (list any other approved over-the counter drugs)

_____________________________________________________________________________

CHILDREN ON CAMPUS

I understand that these over-the-counter medications are not necessarily kept on-hand and available to be administered immediately. Program staff will use generic equivalents when available for the name-brand over-the-counter medications listed above. I understand that the administration of OTC medication will not be done under the supervision of medical personnel.

Any condition which is associated with fever, significant inflammation, and/or does not respond to the above outlined OTC treatment will be followed-up by a consultation with the Participant’s

parent/guardian. Parent/Guardian will be contacted if any conditions develop requiring treatment with any of the above over-the-counter medications that are not checked. I authorize the administration of checked OTC medications to my child as indicated above and general first aid treatment.


First Camper's Name
First Name*
Last Name*
Phone*
First Camper's Date of Birth*
Date of Birth
First Camper's Signature*
Second Camper's Name
First Name*
Last Name*
Camper's Date of Birth*
Date of Birth
Third Camper's Name
First Name*
Last Name*
Camper's Date of Birth*
Date of Birth
Fourth Camper's Name
First Name*
Last Name*
Camper's Date of Birth*
Date of Birth
Fifth Camper's Name
First Name*
Last Name*
Camper's Date of Birth*
Date of Birth
Sixth Camper's Name
First Name*
Last Name*
Camper's Date of Birth*
Date of Birth
Seventh Camper's Name
First Name*
Last Name*
Camper's Date of Birth*
Date of Birth
Eighth Camper's Name
First Name*
Last Name*
Camper's Date of Birth*
Date of Birth
Ninth Camper's Name
First Name*
Last Name*
Camper's Date of Birth*
Date of Birth
Tenth Camper's Name
First Name*
Last Name*
Camper's Date of Birth*
Date of Birth
Parent or Guardian's Email Address
Email
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
I give permission for the Program staff to administer the following medications to my Participant consistent with medication directions, if the need arises. o Sudafed as directed for nasal congestion and allergy relief o Benadryl for swelling, hives, allergic reaction o Bug repellant o Calamine lotion for bug bites and poison ivy o Hydrocortisone cream for mild skin irritations, poison ivy and insect bites o Ibuprofen o Imodium for diarrhea o Medicated lip ointment for dry, chapped lips, lip blisters or canker sores o Medicated powder for skin irritation o Ointments for minor wound care, such as an antiseptic, anti-itch, anti-sting, antibiotic or sunburn cream o Pepto Bismol or Mylanta for upset stomach or nausea. o Rolaids or Tums for acid reflux, heartburn or indigestion o Sunscreen o Swimmer’s ear drops o Throat lozenges and or spray for sore throat o Tylenol/Acetaminophen o Visine or another eye drops for minor eye irritation. o Other (list any other approved over-the counter drugs) _____________________________________________________________________________ CHILDREN ON CAMPUS I understand that these over-the-counter medications are not necessarily kept on-hand and available to be administered immediately. Program staff will use generic equivalents when available for the name-brand over-the-counter medications listed above. I understand that the administration of OTC medication will not be done under the supervision of medical personnel. Any condition which is associated with fever, significant inflammation, and/or does not respond to the above outlined OTC treatment will be followed-up by a consultation with the Participant’s parent/guardian. Parent/Guardian will be contacted if any conditions develop requiring treatment with any of the above over-the-counter medications that are not checked. I authorize the administration of checked OTC medications to my child as indicated above and general first aid treatment.
I give permission to administer medication as stated above.*
No
Yes
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Last Name*
Relationship*
Phone*
Parent or Guardian's Date of Birth*
Date of Birth
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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