Program Fees

There are two package options available:

1. If you wish to provide your own cook, food, and materials for the jobs you want to work on, the cost is $25 per night per person.
 
2. C.M.O. is able to provide you with a hometown cook, she provides all the food and a cooking. The cost is $50 per person per day.

You will need to bring tools, and cover all your team's materials , if you choose to help a family in the mountains. Go to Cumberland Mountain on facebook to see your options.

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 Group Registration Form
Please complete this form to provide us with contact and payment information for your entire group

Church Name________________________________     
 Contact Leader Name___________________________________

Address          ________________________________    
  Contact Leader Phone Number__________________________

                             
 Contact Leader Email Address ___________________________

Total Number of Campers (One leader required for every 5 minors)_________________________________

Dietary Options (Check one)     
 Catered in (ad an addition $25 per day)____
Prepare your own (no additional cost)____

Payment Slip

Number of campers with meals catered ___ X $50 (per day) = _____

Number of campers without meals catered__ X $25 (per day) =  ____

For information please call Cindy Evanoff at 606-464-8134

Camp Activities Options (Check one)
 Providing a 3 Day VBS Day Camp____ 
Orchestrate a Home Repair(tools and materials required)____
Oct. 20-23 Woolly Worm  Street Festival_____
Aug.24-27 Homecoming Fair _____
Dec. 17 Christmas Party ____
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ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM

Date of Activity or Event :________________( Check all that apply) Home Repair____ Kid’s Camp____

I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING AND/OR VOLUNTEERING IN THIS ACTIVITY OR EVENT, including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the person or entities being released, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault.

I certify that I am physically fit, have sufficiently prepared or trained for participation in the activity or event, and have not been advised to not participate by a qualified medical professional.  I certify that there are no health-related reasons or problems which preclude my participation in this activity or event.

I acknowledge that this Accident Waiver and Release of Liability Form will be used by the event holders, sponsors, and organizers of the activity or event in which I may participate, and that it will govern my actions and responsibilities at said activity or event.

In consideration of my application and permitting me to participate in this event, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows:

(A) I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this event. THE FOLLOWING ENTITIES OR PERSONS: Cumberland Mountain Outreach and/or their directors, officers, employees, volunteers, representative, and agents, the activity or event holders, activity or event sponsors, activity or event volunteers;

(B) I INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE The entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this activity or event volunteers, whether caused by the negligence of release or otherwise.

I acknowledge that the Cumberland Mountain Outreach and their directors, officers, volunteers, representatives, and agents are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific event or activity on behalf of the Cumberland Mountain Outreach.

I acknowledge that this activity or event may involve a test of a person’s physical and mental limits and may carry with it the potential for death, serious injury, and property loss.  The risks may include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of participants, equipment, vehicular traffic, actions of other people including, but not limited to participants, volunteers, spectators, coaches, event officials, and event monitors, and/or producers of the event, and lack of hydration.  risks are not only inherent to participants, but are also present for volunteers.

I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during this activity or event.

I understand that at this event or related activities, I may be photographed.  I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by the event holders, producers, sponsors, organizers, and assigns.

The accident waiver and release of liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.

I understand that all claims will fall under my personal insurance and that of my attending church for any activity while in attendance.

I CERTIFY THAT I HAVE READ THIS DOCUMENT, AND FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL.

_________________________________         _____       _______________________

Print Participant’s Name                                    Age       Signature (if under 18 years old,                                                           Parent or guardian)       

                                                            

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Check List

___Signed Liability Waiver for each camper  ___Copy of Church Activity Insurance  ___Registration Form for Group ____

Payment Due upon arrival


 Cumberland Mountain Outreach
 102 East Third St.
 Beattyville, KY 41311
 606-464-8134
 E-mail:  Cmoky@att.net or CMO@cumberlandmountaionoutreach.org
Contact Information

We would love to hear from you! Please fill out our Contact Information form below and we will get back shortly. If you have not heard from us in three day call 606-464-8134.

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