Campcomo.com

ADULT FACULTY REGISTRATION
To be completed in full and mailed to: Camp Como, P.O. Box 36, Como, CO 80432 Event registering for: ________________________________ HEALTH HISTORY:
Date of Event: ______________________________________ List food or medication allergies/special dietary needs: Faculty/sponsor name: _______________________________ ______________________________________________________ List communicable diseases, serious illnesses or surgeries with D.O.B. _____/_____/_____ □ Male □ Female dates:_________________________________________________ Address: __________________________________________ List any prescriptive or non-prescriptive medication which camper City: ______________________ State:_____ Zip: ________ MUST TAKE REGULARLY: (list additional med’s on back)
Medication (Dosage, Frequency, Reason Taking, Physician)
Church you attend: __________________________________ ______________________________________________________ Church you are registering with: ________________________ Describe any special physical or emotional needs: Emergency Contact Name: ____________________________ ______________________________________________________ Emergency Contact Phone: ____________________________ ______________________________________________________ WAIVER AND RELEASE
All information provided on this form is correct to the best of my knowledge. In case of emergency, I understand that every effort will be made to contact my Emergency Contact. I give Camp Como permission to seek medical treatment for myself in case of emergency. I give Camp Como medical staff permission to provide me with medical treatment which may include, but is not limited to: the use of Tylenol, Ibuprofen, Benadryl, Rolaids, Cough Medicine, Chlorpheniramine (allergy med), Benadryl Cream, Caladryl, Triple Antibiotic Ointment, Pseudofed, Claritin, or generic equivalents to these medications, physician consultation, urgent, emergent, and non-emergent medical treatment. I understand that the private health information on this form will only be used and shared for the purposes of medical treatment. I agree to indemnify and hold harmless Camp Como and their employees from any and all claims, damages, losses, injuries and expenses arising out of or resulting from my participation in Camp Como activities. Please Note any exceptions to treatment: _____________________________________________________________________________________ FACULTY JOB DESCRIPTION
As a volunteer junior faculty member, I am aware that my duties are t o be done in compliance with the acting Program Director and the policies of Camp Como during my stay. All of my responsibilities will come directly from them. I also am aware that my personal conduct is to be Christ-like and appropriate for the program that is in progress. I have not been convicted or accused of child abuse or misconduct. I have read and agree to the “Faculty Job Description”.

Describe your duties for this week of camp:
_________________________________________________________________ ___________________________________________________________________ ____________________________________________________________________________________________________________________________________ _____________________________________________________ __ _______________________________________________________

Source: http://www.campcomo.com/library/Adult_Faculty_Registration_Form.pdf