In order to complete the candidate application process, we must collect health information to best serve you on the weekend.  This information will be kept confidential and only shared with critical personnel on the weekend.  In addition, we need your consent for release of South East Texas Tres Dias (SETTD) and a waiver of claim for Camp Blessing, where SETTD takes place.

Please proceed to the next few pages to fill out these forms.

Questions? Please email: preweekend@settd.org

IN AN EMERGENCY, CONTACT:

PERMISSION TO PROVIDE NECESSARY TREATMENT OR EMERGENCY CARE

I hereby give permission to the medical personnel selected by the camp staff to order X-rays, routine tests, treatment; to release any records necessary for insurance purposes; and to provide or arrange necessary related transportation for me. I further, hereby give permission to the physician selected by the camp staff to secure and administer treatment, including hospitalization, anesthesia, surgery, or any other medical decision.

By selecting Yes, {name17} is giving permission to medical personnel.

PHYSICIANS INFORMATION

MEDICAL INFORMATION

Carolina Creek has a Camper Insurance program which uses the campers existing Medical Insurance Policy as the primary coverage provider and uses the Camp insurance as the secondary provider. The Staff at Carolina Creek will attempt to contact the emergency contact as listed at the top of this waiver as soon as possible and will keep them up-to-date concerning the condition and treatment of the Attendee.

WAIVER OF CLAIM FOR CAMP BLESSING ACTIVITIES

This Waiver of Claim (the “Waiver”) is given for the following purposes:

1. I hereby desire to participate in various activities while on or about the premises of Camp Blessing on {servingOn}, without any supervision supplied by Camp Blessing.
2. I recognize that although the odds of serious injury or death is low, nevertheless, a body that slips or falls may have a reaction to the immediate injury or the treatment for such injury that results in a medical condition that could lead to serious injury or death.
3. I agree that in exchange for Camp Blessing allowing me to participate in the activities on the premises that I in my individual capacities will not assert or pursue a claim for personal injury against Camp Blessing or any person or entity or fellow participant that conducts or participates in any activity on the premises. More specifically, I hereby WAIVE and RENOUNCE and RELEASE any claim for personal injury suffered by me during activities regardless of the cause of the injury, that is, regardless of whether the injury is caused by participating in the a planned activity or injury caused by movement on the premises or the mere going to and from the site where the activity takes place and regardless of whether the injury is caused by the negligence of any person or entity involved in the activity or the condition of the premises where the activity takes place SAVE and EXCEPT injury caused by gross negligence of Camp Blessing acting through its agents, servants, employees, officers, directors or owners.
4. I agree that if any claim is brought by any participant against Camp Blessing or any employee, agent, owner, director or officer of Camp Blessing because of my actions or omissions while participating in activities on the premises of Camp Blessing, I shall INDEMNIFY and HOLD HARMLESS Camp Blessing, its employees, agents, owners, officers and directors from and against any such claim including the duty to investigate, defend and pay on the part of Camp Blessing.
5. Texas law governs the interpretation and enforcement of this Waiver. Venue of any dispute will be in the county where Sandy Creek is located. Any claim shall be first discussed among the claimant(s) and Camp Blessing before any suit if filed by way of face-to-face meeting on the premises, and thereafter, by way of non-binding mediation BEFORE suit to  interpret or enforce is filed.

Select "Yes" if you agree with this waiver:

RELEASE FOR SOUTH EAST TEXAS TRES DIAS

I understand that South East Texas Tres Dias (“SETTD”) does not own the camp where my Tres Dias Weekend will take place, and has limited control over the facility. I therefore agree to release and indemnify SETTD to the same extent that I release and indemnify Camp Blessing for any and all injuries which I may receive while participating in the Weekend. I further and expressly release, indemnify and hold harmless SETTD, its officers and directors, and any volunteers participating in my Weekend from any and all claims for personal injury, death, or loss or destruction of property. I further represent and warrant that I have disclosed in writing to SETTD, on this medical forms, each and every medical condition or issue I am aware of having which does or could require medications, special diets, sleeping accommodations, restrooms or other special considerations or facilities. I am not aware of any physical, mental or emotional limitations I have which would make it difficult for me participate in normal day-to-day activities.

Select "Yes" if you agree:

Please complete the Waiver below for Camp Blessing. Once completed, please select Submit below to submit your Health Forms. You must complete the entire form and sign it electronically to receive credit for signing your waiver.

To sign, click Start Signing below and follow the prompts. You will receive an email once completed. To open the pdf you will be sent, use the password SETTD. 

Once the Waiver has been filled out, you must select Submit below to complete the Health Form.