Location Information

  • St. Therese's Camp
  • 7180 E. Twin Lakes Dr., Wasilla, AK, 99654 US

CAMPER Information

PARENT/Guardian Information

1. This form MUST be completed by a PARENT OR GUARDIAN.

2. All correspondence will be sent to this email address from ***. 

Emergency Contact Information

Please supply an Emergency Contact that does not live with you.

Camper Details

Cabin mate requests will be honored to the best of our ability.  Campers must be in the same grade band (3-5 or 6-8) and be the same sex in order to be cabin mates.

Dietary Restrictions

Health Information

Please verify that your children's tetanus shots are up to date before they come to camp.

For the safety of your child, please list details about any allergies in the box below

Covid Release

RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISKS, AND INDEMNITY AGREEMENT. 1. Parties. This Release-Waiver-Assumption of Risk-Indemnity Agreement is entered into between Guest, the parent/guardian of Guest, and CATHOLIC CAMP AND CONFERENCE MINISTRIES OF ALASKA, INC., dba ST. THERESE’S CAMP (“CAMP”), its agents, employees, staff, owners, directors, officers, participants, and all other persons or entities acting in any capacity on its behalf. 2. Assumption of Risk. Guest expressly understands and agrees that Guest’s use of CAMP’s facilities and premises presents known and inherent risks to Guest regarding any potential and/or actual infection of Covid-19 and/or any related illness, the result of which may be both serious and minor, including but not limited to, cough, fever, pneumonia, hospitalization, and death. Guest is responsible for evaluating the risks that he or she may face. Guest has done so, and by signature below and engaging in CAMP activity, in exchange for the opportunity to voluntarily participate in CAMP and CAMP activity, has assumed the risks and is responsible for his or her actions. Guest further recognizes, understands, and agrees that CAMP’s agents, employees, staff, owners, directors, officers, participants are NOT infallible, and that CAMP assumes no responsibility for any liability, damage, or injury relating to or resulting from Covid-19 that may be caused by the negligent, grossly negligent, or willful acts or omissions committed prior to, during, or after use of CAMP’s facilities and premises by Guest. BY SELECTING YES, I EXPRESSLY AGREE AND PROMISE TO ACCEPT AND ASSUME ALL THESE RISKS TO MYSELF OR MY CHILD. 3. Acknowledgment of Unknown Scope of Risk of Covid-19. Guest and CAMP hereby acknowledge that the scope of risks related to Covid-19 are unknown, but that CAMP will seek to stay apprised of any recommendations of the CDC and will consider action accordingly, and may remove any safety measures listed herein once the CDC or the United States, state, or local governments deem such measures are no longer necessary. Guest acknowledges that it will also take certain safety measures to help prevent, as best it reasonably can, infection or spread of Covid-19. Such safety measures include: ensuring that Guest does not have any symptoms of Covid-19 prior to entrance onto or use of CAMP’s facilities and premises, use of handwashing and hand sanitizer on a regular basis while on the CAMP’s premises, maintaining social distancing and proper use of face masks as indicated by CAMP. In the event that the CDC recommends additional safety measures, Guest agrees to pursue utilization of such safety measures upon verbal or written request of CAMP. BY SELECTING YES, I ACKNOWLEDGE THAT I AM ULTIMATELY RESPONSIBLE FOR MY OWN SAFETY AND MY CHILD’S DURING MY USE OR MY CHILD’S USE OF OR PARTICIPATION IN CAMP’S FACILITIES, EQUIPMENT, RENTALS, OR ACTIVITIES. 4. Indemnification and Hold Harmless. Guest specifically understands that it is personally responsible for its actions and omissions, and any resulting sicknesses or injuries relating to or resulting from Covid-19 and agrees to indemnify, defend, and hold harmless, including from reasonable attorneys' fees and/or any other associated costs, CAMP, and its predecessors, successors, assigns, officers, directors, trustees, faculty, employees, volunteers, agents, and legal representatives, from any and all actions, claims, or demands that Guest, and assigns, have or may have for any and all sicknesses or injuries relating to or resulting from Covid-19, Guest may suffer or sustain, regardless of cause or fault, as a result of his/her voluntary decision to utilize the facilities and premises of CAMP, caused by any act or omission of CAMP and/or Guest, its employees, visitors, and guests resulting from utilizing the facilities and premises of CAMP. 5. Non-Essential Nature of Camp. Guest hereby acknowledges that the CAMP, while a providing a desirable opportunity for Guest, is not an essential service, that Guest has a choice whether to attend Camp or not, and that a release is required in order for Guest to participate. 6. WAIVER OF CLAIMS. In consideration of being allowed to utilize CAMP’s facilities and premises, Guest (referred to herein as "Releasor"), hereby waives any and all claims, demands, damages, actions, or suits, in law or in equity, whether heretofore or hereafter accruing, or whether now known or not known to the parties, which may arise from any negligent or grossly negligent act or omission of CAMP, or its predecessors, successors, assigns, officers, directors, trustees, faculty, employees, volunteers, agents, or legal representatives (collectively referred to herein as "Releasees"), including but not limited to claims for negligence, gross negligence, personal injury, and mental anguish, for or because of anything done or omitted, or suffered to be done, directly or indirectly related to Guest’s use of and entrance upon CAMP’s facilities and premises relating to or resulting from possible or actual exposure to Covid-19. Releasor further waives any and all liability of Releasees for their negligence or gross negligence causing any accident, illness, injury, loss or damage to personal property, or any other consequences arising or resulting directly or indirectly from Guest’s use of and entrance upon CAMP’s facilities and premises. Releasor acknowledges and agrees that Releasees assume no responsibility for any liability, damage, or injury that may be caused by the negligent, grossly negligent, or willful acts or omissions committed prior to, during, or after Guest’s use of and entrance upon CAMP’s facilities and premises. BY SELECTING YES, RELEASOR/GUEST AND HIS OR HER PARENT OR GUARDIAN IS GIVING UP LEGAL RIGHTS. I HAVE HAD SUFFICIENT OPPORTUNITY TO READ THIS ENTIRE DOCUMENT. I HAVE READ AND UNDERSTOOD IT, AND I AGREE TO BE BOUND BY ITS TERMS AS INDICATED BY MY SELECTING YES.

Liability Release

d/b/a St. Therese’s Camp.


I, on behalf of myself and my minor dependent(s), hereby agree to the following for the attendance at St. Therese’s Camp (“Camp”) by my minor dependent(s):

1. Attendance at Camp may involve a variety of activities including but not limited to physical activities, hiking, boating and other activities, both indoors and outdoors.

2. My minor dependent(s) agrees to abide by all rules and regulations which apply to all participants at Camp programs.

3. My minor dependent(s) understands that fighting, obscene language, sexual impropriety, use and/or possession of tobacco, alcohol, marijuana, illegal drugs or weapons of any kind (including pocket knives, leatherman or any similar tools) are not acceptable and may be grounds for terminating my minor dependent(s) time at Camp. In particular, I understand that if my minor dependent(s) violate any Camp rules, I may be asked to pick-up my minor dependent(s) or have them transported to me at my expense.

4. I understand that enforcement of Camp rules is subject to the sole discretion of the staff of Camp and that early termination of my minor dependent(s) participation in Camp activities for violation of Camp rules and regulations is not appealable.

5. I understand and grant permission for my minor dependent(s) to attend and participate in all activities held at Camp. In the case of a medical emergency, I understand that every effort will be made to contact the emergency contacts noted below. If Camp personnel cannot contact any of the emergency contacts or if the contacts don’t respond in a timely manner, I hereby grant permission for my minor dependent(s) to be evaluated, diagnosed and/or medicated in accordance with standard medical practice by licensed medical personnel. I agree to accept and assume any and all financial responsibility as a result of any treatment for such medical emergency.

6. In consideration for being permitted to access and use Camp facilities and to participate in the programs and activities sponsored by the Camp, I, on behalf of myself, my minor dependent(s), our heirs, successors and assigns, do hereby forever release and discharge Camp, its owners, officers, employees, agents, assigns and successors from all claims, demands, causes of action, lawsuits and liability for any injury or damages of any nature whatsoever, including death, incurred while using Camp’s facilities or equipment or while participating in any Camp sponsored activity.

6.1 Included in the foregoing waiver and release of claims are those injuries, deaths or damages arising from alleged negligent acts or omissions on the part of the Camp, its officers, employees or volunteers.

7. Further, in consideration of the use of Camp facilities and participation in activities and programs sponsored by Camp, I release and discharge Camp from any claim for personal property damage or for lost or stolen personal property in or about Camp, or in lockers, cabins or other similar places or for loss or damage to any property including but not limited to automobiles and contents thereof while on Camp premises.

8. I understand and agree that my minor dependent(s) and/or their work may be photographed or recorded during their time at Camp. I grant permission for photographs and recordings to be featured on the Camp’s website, displayed at Camp or included in promotional materials or reports.

9. I hereby represent that I am the parent, natural guardian or legal guardian of the minor dependent(s) listed below and, in such capacity, agree to defend, indemnify and hold harmless each of the parties referred to above from all liability, loss, claim or damage whatsoever which may be imposed upon the parties because of any defect in or lack of my capacity to so act and I hereby release the parties on behalf of my minor dependent(s).

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