Tier III – Waitlist

Name: Tier III - Waitlist
SKU: 2666
Price: 550.00 USD
Availability: InStock

$550.00

By completing this form and paying the $50 deposit, your camper will be placed on the list for the session that you select. The $50 deposit is fully refundable if we receive notice that you would like to be removed from the waitlist via email two weeks before the session begins. Contact [email protected]

Please select the name of the session for which you wish to register.(Required)

Mixed Ages _ July 8 - July 13

Middler _ June 24 – June 29

Junior _ June 17 - June 22

Session ages are based on the age of the camper at the start of the camp session.

Participant Contact and Profile Information

Required fields are indicated with an ASTERISK.

Camper(Required)

First Last

Date of Birth(Required)

Camper Age(Required)

Gender(Required)

Female

Male

Preferred Pronouns

Grade in the 2023 - 2024 School Year(Required)

Parent/Guardian Name(Required)

First Last

Parent/Guardian Email(Required)

Phone(Required)

Camper Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

How did you find out about Camp Bratton-Green?(Required)

Is this your camper's first camp experience?(Required)

Yes

Inclusive Cabins

It is the belief of Gray Center and Camp Bratton-Green that no one should be excluded from any programming based on their race, color, gender, gender identity, or sexual orientation. This includes transgender campers or staff. With this spirit of inclusion in mind, we offer, when needed, gender inclusive cabins. These cabins welcome transgender campers to be housed in the cabin that aligns with their gender identity. All cabins make use of separated private changing and shower areas. Please indicate below if you would be willing to allow your camper to be housed in an inclusive cabin should the need arise.

Please select one:(Required)

Yes my camper may be placed in an inclusive cabin.

No I do not wish my camper to be placed in an inclusive cabin.

All Are Welcome! Faith, Religion, & Church

Camp Bratton-Green is a ministry of the Episcopal Church in Mississippi. We strive to offer Christian programs that renew lives and deepen one's walk with Christ which enables service in the world.

Religious Tradition(Required)

Place of Worship

T-Shirt Size(Required)

Youth Small

Youth Large

Adult Small

Adult Medium

Adult Large

Adult XL

Adult 2XL

Dietary Preferences/Restrictions(Required)

No Restrictions

Gluten Allergy

Diabetic

Dairy Allergy

Peanut Allergy

Tree Nut Allergy

Vegetarian

Other

Dietary Details

Other Information?

Emergency Contacts Information

Please provide contact information for TWO contacts other than you who may be contacted in case of an emergency.

Emergency Contact 1(Required)

First Last

Relation to Camper(Required)

Phone Number(Required)

Emergency Contact 2(Required)

First Last

Relation to Camper(Required)

Phone Number(Required)

Authorized to Pick Up Camper(Required)

Names of anyone allowed to pick up your camper other than listed Parent/Guardian and Emergency Contacts. Please type "NONE" if no one else is able to pick up your camper. If there is anyone who is not permitted to pick up your child for legal reasons, please inform the camp staff.

Medical Insurance Information

Participant's Full Legal Name(Required)

First Last

Insurance Company(Required)

Address of Company

Street Address Address Line 2 City State ZIP Code

Policy #(Required)

Group #(Required)

Name of Policy Holder(Required)

First Last

Minor Participant Waiver, Release, Indemnification of All Claims & Covenant Not to Sue

PLEASE READ CAREFULLY. THIS DOCUMENT AFFECTS YOUR LEGAL RIGHTS AND IS LEGALLY BINDING. BY SIGNING THIS AGREEMENT YOU ARE RELEASING THE EPISCOPAL DIOCESE OF MISSISSIPPI (“DIOCESE”), DUNCAN M. GRAY CAMP AND CONFERENCE CENTER (“GRAY CENTER”) AND OTHERS DETAILED BELOW FROM ALL LIABILITY AND FOREVER GIVING UP ANY CLAIMS THEREFOR Assumption of Risk I, in my legal capacity as parent/guardian of the minor named below (“Minor”), acknowledge and agree that any use of Gray Center’s facilities, services, equipment and premises (“Facilities”) and any participation in programs and activities of the Diocese and Gray Center (“Programs”) comes with inherent risks including, but in no way limited to: (1) moderate and severe personal injury, (2) property damage, (3) disability, (4) death, and (5) sickness or disease including, without limitation, COVID-19. I voluntarily, for myself and Minor, accept and assume full responsibility for these risks as well as any and all other risks of the use of Facilities and participation in Programs. I agree that I have full knowledge of the nature and extent of all such risks and am not relying on all such risks being described in this document. Waiver, Release, Indemnification & Covenant Not to Sue In consideration of Minor’s use of Facilities and participation in Programs, I, in my legal capacity as parent/guardian of Minor, agree on behalf of myself and Minor that the Diocese, Gray Center, and, with respect to each of them, its officers, directors, agents, employees, volunteers, insurers and representatives (“Releasees”) will not be liable for any personal injury, property damage, disability, death, sickness or disease incurred by Minor, however occurring, including, but not limited to, the negligence of Releasees. I understand that Minor and I will be solely responsible for any loss or damage, including personal injury, property damage, disability, death, sickness or disease sustained from the use of Facilities and participation in Programs. I further agree, in my legal capacity as the parent/guardian of Minor, on behalf of Minor, myself, and any and all legal successors and proxies, to release and HEREBY DO RELEASE, WAIVE AND COVENANT NOT TO SUE Releases from any causes of action, claims, suits, liabilities or demands of any nature whatsoever including, but in no way limited to, claims of negligence, which Minor, myself, and any and all legal successors and proxies may have, now or in the future, against Releases on account of personal injury, property damage, disability, death, sickness, disease or accident of any kind, arising out of or in any way related to the use of Facilities or participation in Programs, whether that participation is supervised or unsupervised, however the injury or damage occurs, including, but not limited to, the negligence of Releasees. In further consideration of the use of Facilities and participation in Programs, I, in my legal capacity as parent/guardian of Minor, agree on behalf of myself and Minor to INDEMNIFY AND HOLD HARMLESS Releasees from any and all causes of action, claims, demands, losses, suits, liabilities or costs of any nature whatsoever, including claims of negligence, arising out of or in any way related to the use of Facilities and participation in Programs.

Participant's Name(Required)

First Last

Legal Parent/Guardian Electronic Signature(Required)

First Last

Date(Required)

Photo/Video Release Form

I hereby grant the Episcopal Diocese of Mississippi permission in my legal capacity as parent/guardian of the minor named below (“Minor”) to use my likeness and/or that Minor in a photograph or video in any and all publications, including website entries, without payment or any other consideration. I further understand and agree that these materials shall become the property of the Episcopal Diocese of Mississippi and will not be returned to me. I hereby authorize the Episcopal Diocese of Mississippi to edit, alter, copy, exhibit, publish or distribute such photo or video for purposes of publicizing the Episcopal Diocese of Mississippi programs or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. I waive any right to royalties or other compensation arising or related to the use of such photograph or video.

I authorize photos of my child to be used.(Required)

YES

Participant's Name(Required)

First Last

Legal Parent/Guardian Electronic Signature(Required)

First Last

Community Covenant

PRESCRIPTION AND OVER THE COUNTER MEDICINES: All prescription and over the counter medicine must be turned in to the medical staff member or a designated adult. Prescribed medication will be distributed according to the doctor’s prescription by a medical staff member or designated adult. Rescue medicines, including epipens and inhalers, may be kept by participants. TOBACCO USE: Possession or use of any and all tobacco products or “vape pens” is not permitted. DRUGS AND ALCOHOL: Possession or use of alcohol or illegal drugs is not permitted. SEXUAL ACTIVITY: Sexual activity or behavior, sexual misconduct or harassment are not permitted. Viewing of pornography is not permitted. WEAPONS AND FIREWORKS: Fireworks, firearms, knives or any other weapons are not permitted. VULGAR OR BULLYING BEHAVIOR: Anyone may be sent home for use of vulgar language, bullying, activities, or behavior deemed inappropriate or harmful to others. The violation of any of the above will result in the participant being sent home early, with no refund provided.

Legal Parent/Guardian Electronic Signature(Required)

First Last

Total

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Subtotal
Options
Total

Pay a deposit of $50.00 per item

Category: Waitlist

Description

These rates are based on historical charges but do not reflect the actual costs of operating camp, and don’t include any sum for the maintenance of Gray Center for the remainder of the year. The difference in this fee and the actual cost is made up through support of the camping program by the Diocese (from its operating budget and otherwise), the Trustees, and contributions from individuals, churches, and other organizations.

Tier III – Waitlist

Participant Contact and Profile Information

Inclusive Cabins

All Are Welcome! Faith, Religion, & Church

Emergency Contacts Information

Medical Insurance Information

Minor Participant Waiver, Release, Indemnification of All Claims & Covenant Not to Sue

Photo/Video Release Form

Community Covenant

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