Camp Mentor Chaperone

Registration Form

March 6-8, 2020

This is an online registration form and should only be filled out by Camp Counselor/Jr. Leader/Young Adult 18 years or older. None of the information gathered will be shared with outside parties. By completing, you agree that all information you provide is accurate.


To ensure ample time for processing and secure space, please have registration forms and registration cost ($150) turned in by Friday, February 21, 2020.


Under the provisions of the Volunteer Immunity Act, I agree to hold harmless Every Kid Outreach, Inc., (EKO), its’ staff, volunteers, and private providers. This immunity will also include travel.


I authorize EKO, its’ staff, and volunteers to consent to any X-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment, and hospital care, to be rendered under the general or special supervision and on the advice of any physician or dentist licensed under the provision of the Medical Practice Act on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital.


I give permission to be interviewed, photographed, videotaped or used for any pictorial representation for EKO purposes.

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