Branded Men’s Retreat 2024


Join us for BRANDED a weekend of Men's fellowship & a great time. 
Bring all toiletries and bedding for twin-sized bed. 


$75 by 12/01/23


$85 after 12/02/23 or at the door


AGES 13 & UP


Pay via Cash App: $Pinnaclefaith


or Cash or Check (to Camp Kahoka)


 


Gene McIntosh Memorial Skeet Shoot


Kahoka Chili Cook-Off


January 5 - 7, 2024
734 Ben Cartwright Lane
Mountain View AR 72560
Click for a larger map
INFO:   Please note that this form contains limited capacity items which are sold out. They are displayed grayed out and/or are not selectable.



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Billing and Payment
Billing and payment processing for Businesses' events is performed by Member Solutions, Inc. ("MSI"), and this contract is specifically assigned to MSI for all such purposes. Customer knowingly and irrevocably authorizes MSI to charge electronically Customer's bank account and/or credit card for any and all amounts due for Customer's, and anyone registering under Customer's, attendance and participation in the Event. Please note, you may see all or any portion of the following on your bank or credit card statement: "MSI*CHURCHOFGODOFPROPHEC 8882448044 ONLINE REG FEE". Any returned payment will be assessed a $25.00 fee. Any unsuccessful electronic transaction is subject to a $10.00 processing fee. MSI is not responsible for any bank fees incurred by Customer. MSI has the sole right to resubmit returned or declined items (plus applicable fees) without prior notice. BILLING INQUIRIES -- 888-244-8044 or by mail to PO Box 297, Hatboro, PA 19040.

Applicant Agreement
I represent that I am the person who appears on the application above. I acknowledge and agree to the statements, terms and conditions above, as well as any applicable terms and conditions for this registration, and that by typing my name below and completing this registration form, I am electronically signing the document, which will have the same legal effect as the execution of the document by a written signature and shall be valid evidence of my intent and agreement to be bound.

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Registration inquiries:
Tom Thompson
501-353-9674
Tom.thompson@nacogop.org
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 INFORMATON
 
You may pay via Cash App at the cash tag $Pinnaclefaith
 
or with check payable to Camp Kahoka.

EMERGENCY CONTACT INFORMATION
In Consideration of my participation in Camp Kahoka sponsored events and activities, I agree to the following:

1. Waiver and Release: I am fully aware of and appreciate the risks, including the risk of catastrophic injury, paralysis, and even death, as well as other damages and losses, associated with participation in any Camp Kahoka related event and activities.
I further agree on behalf of myself, my heirs and personal representatives, that Camp Kahoka along with leaders, staff, volunteers, employees, agents, sponsors, officers, and directors of these organizations, shall not be liable for any injury, loss of life or other loss or damage occurring as a result of my participation in the event.

2. Medical Attention: I hereby give my consent to Camp Kahoka and it’s agents to provide, through a medical staff of its choice, customary medical attention, transportation and emergency medical services as warranted in the course of my participation in Camp Kahoka sponsored or sanctioned events.

3. Readiness to Compete: I will only participate in those competitions or activities in which I believe I am physically and psychologically prepared to participate.

As legal guardian of this participant, I herby verify by my signature below that I have read and fully understand each of the conditions under Participant Waiver and Release section for permitting my child to participate in any Camp Kahoka sponsored events and activities and I accept each of the conditions, especially the waiver and release set forth in paragraph one.

Insurance Information
All participants are required to be covered with insurance for accidental injury. In most instances, family health insurance is adequate. Please indicate your family health insurance plan above.

Medical Treatment Authorization
I/We being the legal guardians of the applicant authorize Camp Kahoka and its agent’s permission to request medical treatment as necessary to insure the well being of our dependent.

I UNDERSTAND THAT CAMP KAHOKA IS A MINISTRY OF THE CHURCH OF GOD OF PROPHECY AND CONSEQUENTLY ALL ACTIONS, CONDUCT, AND POLICIES WILL BE CONSISTENT WITH THE CHURCH’S STATEMENT OF DOCTRINE AND BELIEFS. IN CASE OF AN EMERGENCY, I UNDERSTAND THAT EVERY EFFORT WILL BE MADE TO CONTACT EMERGENCY CONTACT OR ME (PARENT OR GUARDIAN). IN THE EVENT I CANNOT BE REACHED, I HEREBY GIVE PERMISSIONTO CAMP KAHOKA ADMINISTRATION, DIRECTORS, STAFF AND PHYSICIANS SELECTED BYT THE CAMP TO SECURE PROPER TREATMENT FOR, TO ADMINISTER “OVER-THE-COUNTER” (OTC) OR PRESCRIPTION MEDICATIONS, TO HOSPITALIZE, ORDER INJECTION, ANESTHESIA, AND /OR SURGERY FOR THE CAMPER. I UNDERSTAND THAT MY INSURANCE HAS THE PRIMARY RESPONSIBILITY OF PAYMENT SHOULD I/MY CHILD NEED TREATMENT. THE CAMP INSURANCE IS SECONDARY. I UNDERSTAND THAT ALL MEDCIATIONS, INCLUDING OTC MUST BE ADMINISTERED BY THE CAMP MEDICAL PERSONNEL AND THAT MEDICATIONS WILL BE COLLECTED AT THE TIME OF REGISTRATION. I CERTIFY THAT ALL INFORMATION PROVIDE ON THIS APPLICATION IS ACCURATE TO THE BEST OF MY KNOWLEDGE. I HAVE READ AND UNDERSTAND THE CAMP RULES AND REGULATIONS AND ALSO UNDERSTAND THAT BY SIGNING THIS APPLICATION REGISTRANT AGREES TO ABIDE BY THOSE RULES. I UNDERSTAND THAT FAILURE TO DO SO COULD RESULT IN DISMISSAL FROM CAMP. ANY CONDUCT INCOMPATIBLE, INCONSISTENT, OR CONFLICTING WITH THE MISSION OF CAMP KAHOKA AS A CHRISTIAN CAMP WILL CONSTITUTE REASON OR CAUSE FOR DISMISSAL FROM CAMP AND/OR THE DECISION TO REFUSE ACCEPTANCE TO FUTURE CAMPS. I ALSO AGREE THAT THE CHURCH OF GOD OF PROPHECY (LOCAL, REGIONAL, AND INTERNATIONAL OFFICES) AND ITS OFFICERS, SERVANTS, AND STAFF SHALL NOT BE HELD RESPONSIBLE FOR DAMAGES FOR ANY ACCIDENT OR SICKENESS INVOLVING MY CHILD/ME.
I HEREBY AGREE THAT I/MY CHILD/WARD/I MAY PARTICIPATE IN ALL CAMP ACTIVITIES INCLUDING TRAVEL OFF THE PROPERTY. I GIVE MY PERMISSION OF CAMP KAHOKA ADMINISTRATION TO USE IMAGES AND RECORDINGS OF MY CHILD/WARD/MYSELF (INCLUDING SOCIAL MEDIA OR WEBSITE USE) WITHOUT FURTHER COMPENATATION. I ALSO AGREE TO HOLD HARMLESS CAMP KAHOKA, ITS STAFF AND VOLUNTEERS FROM ANY AND ALL LIABILITIES, CLAIMS, DEMANDS, AND CAUSES OF ACTION WHATSOEVER, WHICH MAY ARISE DUE TO THE PARTICIPATION OF MYSELF, OR MY CHILD/WARD IN SAID ACTIVITIES. . I ACKNOWLEDGE THAT TYPING MY NAME BELOW AND COMPLETING THIS REGISTRATION FORM, I AM ELECTRONICALLY SIGNING THE DOCUMENT, WHICH WILL HAVE THE SAME LEGAL EFFECT AS THE EXECUTION OF THE DOCUMENT BY A WRITTEN SIGNATURE AND SHALL BE VALID EVIDENCE OF MY INTENT AND AGREEMENT TO BE BOUND. PARENT OR GUARDIAN MUST SIGN IF UNDER 18

CAMP KAHOKA HAS PUT IN PLACE PREVENTATIVE MEASURES TO REDUCE THE SPREAD OF COVID-19; HOWEVER, CAMP KAHOKA CANNOT GUARANTEE THAT YOU OR YOUR CHILD(REN) WILL NOT BECOME INFECTED WITH COVID-19. FURTHER, ATTENDING CAMP KAHOKA COULD INCREASE YOUR RISK OF CONTRACTING COVID-19. BY SIGNING THIS AGREEMENT, I ACKNOWLEDGE THE CONTAGIOUS NATURE OF COVID-19 AND VOLUNTARILY ASSUME THE RISK THAT I/MY CHILD(REN)/I MAY BE EXPOSED TO OR INFECTED BY COVID-19 BY ATTENDING CAMP KAHOKA AND THAT SUCH EXPOSURE OR INFECTION MAY RESULT IN PERSONAL INJURY, ILLNESS, PERMANENT DISABILITY, AND DEATH. I UNDERSTAND THAT THE RISK OF BECOMING EXPOSED TO OR INFECTED BY COVID-19 AT CAMP KAHOKA MAY RESULT FROM THE ACTIONS, OMISSIONS, OR NEGLIGENCE OF MYSELF AND OTHERS, INCLUDING, BUT NOT LIMITED TO, CAMP KAHOKA EMPLOYEES, VOLUNTEERS, AND PROGRAM PARTICIPANTS AND THEIR FAMILIES.

I UNDERSTAND THAT I/MY CHILD(REN)/ I MUST BE FREE FROM COVID-19 SYMPTOMS, AND SHOULD SYMPTOMS DEVELOP WHILE IN THE CARE OF CAMP KAHOKA, MY CHILD(REN)/ I WILL BE SEPARATED FROM THE REST OF THE CAMP PARTICIPANTS/STAFF. I WILL BE CONTACTED, AND MY CHILD MUST BE PICKED UP WITHIN THREE HOURS OF MY BEING NOTIFIED. I FURTHER VOLUNTARILY AGREE THAT CAMP KAHOKA MAY MONITOR MYSELF OR MY CHILD(REN) FOR SYMPTOMS OF COVID-19 (INCLUDING, BUT NOT LIMITED TO, FEVER OF 100.4 DEGREES FAHRENHEIT OR HIGHER, SHORTNESS OF BREATH, CHILD, DRY COUGH, SORE THROAT, AND MUSCLE ACHES)
I WILL IMMEDIATELY NOTIFY CAMP MANAGEMENT IF I BECOME AWARE OF ANY PERSON WITH WHOM I/MY CHILD OR I HAVE HAD CONTACT EXHIBITS ANY SYMPTOMS OF COVID-19, IS ADVISED TO SELF-ISOLATE, QUARANTINE, OR HAS TESTED POSITIVE FOR COVID-19.

I VOLUNTARILY AGREE TO ASSUME ALL OF THE FOREGOING RISKS AND ACCEPT SOLE RESPONSIBILITY FOR ANY INJURY TO MY CHILD(REN) OR MYSELF (INCLUDING BUT NOT LIMITED TO, PERSONAL INJURY, DISABILITY, AND DEATH, ILLNESS, DAMAGE, LOSS, CLAIM, LIABILITY, OR EXPENSE, OF ANY KIND, THAT I MAY EXPERIENCE OR INCUR IN CONNECTION WITH MY ATTENDANCE AT CAMP OR PARTICIPATION IN CAMP PROGRAMMING (“CLAIMS”) ON MY BEHALF, I HEREBY RELEASE, COVENANT NOT TO SUE, DISCHARGE, AND FOREVER HOLD HARMLESS CAMP KAHOKA, THE CHURCH OF GOD OF PROPHECY, ITS BOARD, DIRECTORS, OFFICERS, EMPLOYEES, AGENTS, CONTRACTORS AND AFFILIATES AS WELL AS THE RELEASE PARTIES AND REPRESENTATIVES OF AND FROM THE CLAIMS, INCLUDING ALL LIABILITIES, CLAIMS, ACTIONS, DAMAGES, COSTS OR EXPENSES OF ANY KIND ARISING OUT OF OR RELATING THERETO. I UNDERSTAND AND AGREE THAT THIS RELEASE INCLUDES ANY CLAIMS BASED ON THE ACTIONS, OMISSIONS, OR NEGLIGENCE OF THE CAMP, ITS EMPLOYEES, AGENTS, AND REPRESENTATIVES, WHETHER A COVID-19 INFECTIONS OCCURS BEFORE, DURING OR AFTER PARTICIPATION IN ANY CAMP PROGRAM.
IN WITNESS WHEREOF EACH PARTY HERETO HAS EXECUTED THIS WAIVER BY ITS AUTHORIZED SIGNATORY AS OF THE DAY, MONTH, AND YEAR INDICATED BELOW, AND THE WAIVER BECOMES EFFECTIVE UPON THE DATE OF THE LAST SIGNATURE HERETO. PARENT OR GUARDIAN MUST SIGN IF UNDER 18.

Check this box to indicate that you have read and agree to all of the above terms & conditions