This form is for those who wish to be a Camper,  Junior Mentor, or Mentor in Training at a week or more of the 2023 Camp Miracles and MUST be completed by a Parent or Guardian.

Application Requirements: 

• Your application must be approved by Jamison or Laura Hicks.
• You must be between the ages of 8-17.
  • Junior mentors- you must be between the ages of 14-16 and attend at least 2 previous camp miracles sessions. You will need a recommendation from Jamison and Laura prior to serving as a junior mentor. 
  • Mentors in training- You must be between the ages of 16-20 and previously served as a junior mentor, or come through recommendations of youth recovery mode (18 and older must complete references and clearances in order to participate as a mentor). You will need a recommendation from Jamison and Laura prior to serving as a mentor in training. 
  • If you would like to mentor but are over 20 you may volunteer through the hopeforkids.org/volunteers web page and apply through there. Those spots are limited. 

The fee for each week is $25 per camper/mentors, payable by Venmo @Hope-for-Kids, cash or cashiers check.

You will have access to change your registration information. Please note that you can transfer your registration, get refunded for your registration, but we cannot guarantee a spot will be open. Spots are limited. 

Form components: 

1. Select the type of participant you are completing the form for: Camper, Junior Mentor, or Mentor in Training 

2. Complete the applicant information portion 

3. Complete the medical information 

4. Complete the waiver 

5. Submit payment: options to pay a deposit of $25 or in full 

2023 Camp Miracles Weeks

CM 1: June 14-17 (shortened version to start the summer)

CM 2: July 3-7

CM 3: July 17-21

CM 4: July 24-28

Please complete the form below to apply.

MUST BE COMPLETED BY PARENT/LEGAL GUARDIAN.

ALLERGIES

List all known allergies and describe how each reaction is managed.

If no known allergies, please write NONE.

General Questions: Has/Does the attendee:

MEDICATIONS TAKEN

Please list ALL medications (including over-the-counter or non-prescription drugs) taken routinely. Be sure that the attendee brings enough medication to last the entire time at camp in the original package/bottle that identifies the prescribing physician, name of drug, dosage, and frequency. This will be given to the camp nurse upon arrival.

PERMISSION TO ADMINISTER 

OVER THE COUNTER MEDICATION

Please indicate your permission to administer over-the-counter medications while the applicant is at camp.

WAIVER AND RELEASE OF LIABILITY

This Release and Waiver of Liability (the "Release") is in favor of Hope for Kids, Inc., a nonprofit organization, and The Solomon Foundation and each of their directors, officers, employees, and agents. I, hereby freely and voluntarily, without duress, execute this Release under the following terms:

In consideration of the risk of injury while participating as a camper at the property owned by The Solomon Foundation and leased by Hope for Kids, Inc. (including but not limited to: swimming, sports, boating, hiking, rock wall climbing and zip-lining), and as consideration for the right to participate in these Activities, I hereby, for myself, my heirs, executors, administrators, assigns, or personal representatives, knowingly and voluntarily enter into this waiver and release of liability and hereby waive any and all rights, claims or causes of action of any kind whatsoever arising out of my participation as a volunteer at the Forge , and do hereby release and forever discharge Hope for Kids, Inc. & The Solomon Foundation , located at 129 Yerger Rd, Schwenksville, Pennsylvania 19473, their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns, for any physical or psychological injury, including but not limited to illness, exposure to infectious/communicable disease, paralysis, death, damages, economical or emotional loss, that I may suffer as a direct result of my participation in the aforementioned Activities, including traveling to and from an event related to this Activities. 

I acknowledge that participation in the activities described above involve risk to the camper (and to the camper's parents or guardians, if the camper is a minor), and may result in various types of injury including, but not limited to, the following: sickness, exposure to infectious/communicable disease, bodily injury, death, emotional injury, personal injury, property damage, and financial damage.

 In consideration for the opportunity to participate in the activity described above (the “activity”), the camper (or parent/guardian if the camper is a minor) acknowledges and accepts the risks of injury associated with participation in and transportation to and from the activity. The camper (or parent/guardian) accepts personal financial responsibility for any injury or loss sustained during the activity or during transportation to and from the activity, as well as for any medical treatment rendered to the camper that is authorized by the sponsor or its agents, employees, volunteers, or any other representatives (collectively referred to as the “activity sponsor”). Further, the camper (or parent/guardian) releases and promises to indemnify, defend, and hold harmless the activity sponsor for any injury arising directly or indirectly out of the described activity or transportation to and from the activity, whether such injury arises out of the negligence of the activity sponsor, the camper or otherwise. 

If a dispute over this agreement or any claim for damages arises, the camper (or parent or guardian) agrees to resolve the matter through a mutually acceptable alternative dispute resolution process. If the camper (or parent or guardian) and the activity sponsor cannot agree upon such a process, the dispute will be submitted to a three-member arbitration panel for resolution in accordance with the rules of the American Arbitration Association.

By checking the boxes below, I am indicating my agreement to the following statements:

As evidenced by my typed name below, I expressly agree that this Release is intended to be as broad and inclusive as permitted by laws of the State of Pennsylvania in the United States of America, and that this Release shall be governed by and interpreted in accordance with the laws of the State of Pennsylvania. I agree that if in the event that any clause or provision of this Release shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause shall not otherwise affect the remaining provisions of this Release, which shall continue to be enforceable. 

I affirm that I am the PARENT/GUARDIAN for the Applicant and am 18 years or older, and that I am freely signing this agreement. I certify that I have read this agreement, that I fully understand its content and that this release cannot be modified orally. I am aware that this is a release of liability and a contract and that I am agreeing to it of my own free will.