• Kairos Summit- Youth Registration Form

    Parents and legal guardians of minor children are asked to complete this form and return it to Kairos. The information requested is designed to assist Kairos in providing for the safety of minors during the short-term trip "Kairos Summit" for the time period of June 28 - July 2.
  • General Information

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  • All Kairos Summit participants must have medical insurance. If a participant does not have medical insurance, medical insurance must be purchased in advance and specific information pertaining to that policy included above. Kairos, their agents, employees, or volunteers will not be responsible for medical expenses incurred during an adventure trip.

  • Consent and Certification

  • We, the undersigned, being the parents or legal guardians of the participant named above, do hereby consent to the participation of our child in a short-term adventure trip to the above named location. We are aware of the hazards and risks to our child associated with participating in such a trip, including but not being limited to death or injury by accident, illness, weather conditions, inadequate medical services, criminal activity, and random acts of violence and understand that these trips include transportation by car or van, camping, canoeing, hiking, backpacking, swimming, jumping into the water from objects on shore, fishing, and the many outdoor activities normally associated with camping routines in a wilderness environment.

    We certify that our child is physically fit and has no medical conditions that would exclude him or her from participating in this adventure trip.

    We understand that while our child participates in the Kairos Summit to the above named location, he or she is responsible to abide by the rules established by Kairos and the instructions of its representatives. Any infraction of the rules, or of any instructions from an authorized Kairos representative (trip leader, chaperone, or sponsor), can result in the dismissal of our child from the trip. In the event our child is dismissed from further participation in this trip due to a refusal to abide by rules or instructions, we, the undersigned, agree to assume the cost of returning the child to his or her home. We also agree, under these circumstances, to forfeit any right to a refund from Kairos of any pre-paid fees or expenses. We understand that such an action would only be taken after notification of the Trip Leader and the undersigned.

    We also give permission for pictures to be taken that may be used in, but not limited to, Kairos publications, staff newsletters, and shared participant online folders.

  • Medical Questionnaire

  • Medical Treatment Authorization and Insurance Election

  • We understand that we will be notified in the case of a medical emergency involving our child. In the event that we, or either of us, cannot be reached, we authorize the calling of a doctor and the providing of necessary medical services in the event our child is injured or becomes ill. We authorize any one or more of the following persons to make emergency medical care decisions on behalf of our child, if required by law or a health care provider: Stephen Giles or Molly Kilpatrick. We understand that Kairos, or any of their agents, employees, or volunteers, will not be responsible for medical expenses incurred on the basis of this authorization.

    We are aware of the hazards and risks to our child associated with an adventure trip. We understand that the Sword of the Spirit (the parent corporation of Kairos) carries general liability insurance only. We understand that this general liability insurance does not cover medical evacuation and medical treatment for children participating in this activity. It is the parents’ responsibility to provide insurance to cover medical evacuation and medical treatment of their children who participate in Kairos activities.

  • Signature and Payment Information

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  • Make the check out to: The Sword of the Spirit

    In the memo line write: Kairos Summit and the names of the people you're paying for

    Mail to:
    Attn: Kairos Summit
    Kairos
    1417 1/2 E. Michigan Ave.
    Lansing, MI 48912

    Please note: The full transportation cost to and from the trip is not totally included in this price. Transportation from Michigan to the trip sites should be already covered, but not extra expenses along the way (fast food, etc.). Kairos can assist your son in getting to and from the trip start location, but you may be asked to give extra for gas money or to help cover a car pool, depending on the situation.

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      Kairos Summit
      $425.00
        
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