Creative. Curious. Faithful.

757-423-3230
office@gsnorfolk.org
7400 Hampton Blvd.
Norfolk, VA 23505

Registration

Please fill out both forms!

There is a medical release form as well as a camp community covenant form. Both forms need to be completed to secure your child’s registration. 

• Community Covenant •
• Medical Release •

Camp Imagine Community Covenant

The Episcopal Church of the Good Shepherd is committed to providing a safe and secure environment for all participants in all activities. We seek to live the values of the Baptismal Covenant, to seek and serve Christ in all persons and to respect the dignity of every human being.

While attending parish sponsored events:

  • ✓ I will be an active participant in all planned activities, willing to try new things.
  • ✓ I will respect the property of the facilities where the event is occurring.
  • ✓ I will respect the environment and refrain from littering and harming my surroundings.
  • ✓ I will be kind, polite and positive while participating in the event.
  • ✓ I will not engage in inappropriate sexual behavior, this includes: sexual misconduct, sexually explicit communication, or harassment.
  • ✓ I will not enter the sleeping areas of the opposite sex during the event (if applicable).
  • ✓ I will not possess or use any illegal drug, alcohol, tobacco or medication not prescribed to me at the event.
  • ✓ I will not possess any type of weapon (firearms, knives, fireworks, etc.).
  • ✓ I will not use language that degrades any person based on race, creed, ethnicity, gender, color, sex or sexual orientation.
Youth Agreement(Required)
Youth Name(Required)
Type Full Name here to indicate agreement to abide by all above guidelines.
Today's Date(Required)
Parent Agreement(Required)
Parent/Guardian Name(Required)
Type Full Name here to indicate that you give permission for your child to attend Camp Imagine.
Today's Date(Required)

Camp Imagine Parental Permission and Medical Authorization

"*" indicates required fields

This field is for validation purposes and should be left unchanged.
Participant Name*
Birthdate*

I give permission for my child (named above) to attend the events, field trips, and service projects associated with Camp Imagine of The Episcopal Church of the Good Shepherd, (Norfolk, VA). I further give permission for my child to be transported to and from events by hired and volunteer drivers authorized by The Episcopal Church of the Good Shepherd.

Medical Release
I hereby authorize the leaders, volunteers, The Episcopal Church of the Good Shepherd, hospitals, licensed medical or dental providers, and their agents and employees to have access to the information contained in this form and to provide all medical or dental care, routine tests, treatment, and necessary transportation advisable for the health and safety of my child. This authorization includes the authority to consent to any x-ray examinations, anesthetic, medical procedure or treatment, and hospital care under the supervision, and upon the advice of or to be rendered by, a physician or surgeon licensed under the Medical Practice Act or dentist licensed under the Dental Practice Act for my child.

Custody Release
I further authorize the Camp leaders of The Episcopal Church of the Good Shepherd to receive physical custody of my child upon completion of any treatment, and I specifically instruct any treating health facility to surrender physical custody of my child to said adult.

Activity Release
I further give permission for my child to participate in all activities sponsored by Camp Imagine activities and The Episcopal Church Of The Good Shepherd.

Parent/Guardian Name*
Typing your name here serves as your signature to this agreement.
Today's Date*
Emergency Contact Name*
Emergency Contact Address*
Phone Type*
Alternate Phone Type
2nd Emergency Contact Name*
2nd Emergency Contact's Phone Type
Does the camp participant wear contacts/glasses?
You have received this parental consent form to both inform you and to request your permission for your child’s photo/image and name to be published on The Episcopal Church of the Good Shepherd /or any other websites maintained, owned, and/or administrated The Episcopal Church Of The Good Shepherd or UPAC. The law requires that we ask for your permission to use information about your child. Pursuant to law, we will not release any personally identifiable information without prior written consent from you as parent or guardian. Personally identifiable information includes youth names, age, grade, and photo or image. If you, as the parent or guardian, wish to rescind this agreement, you may do so at any time in writing by sending a letter to the Director of Children, Youth and Young Adult Formation, Kim Rogers, and such rescission will take effect upon receipt.
Media Release
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