Welcome to Kid City Summer Camp 2016!!

WelcometoKidCitySummerCamp2016!!
ThankyouforyourregistrationtoKidCitySummerCamp2016!
EnclosedisaKidCitySummerCampInformationPacket.Itcontainscontact&
generalinformationaboutthecampaswellasrulesandreleases.Pleasereview
allthematerialspriortobringingyourchildtocamp.
AllformsforHarvestChristianFellowshipandPlainsBaptistCampgroundmust
becompleted,signed,datedandreturnedbeforeyourchildwillbeallowedto
participateincampactivities.Yourchildwillnotbeabletoattendcampwithout
thesereleasesbeingsignedandturnedin.
WearelookingforwardtoGodblessinguswithagreattimeatKidCityCamp!
KidCitySummerCampStaff2016
EmergencyContactNumbers
HarvestChristianFellowshipChurchOffice
(806) 296-7158
KoriCovington
(806) 773-4518
AmyStevens
(806) 559-9203
ChristelHallford
(806) 786-8430
DanaKimmell
(806) 676-1777
PlainsBaptistCampground-(806)983-3954
If necessary, you may contact us at any one of the numbers listed above. If there is an
emergency,pleasecontactthecampgroundfirstascellphoneserviceisunreliable
inthecanyon.Therewillnotbeaphoneavailableforstudentstocontactparentsorfriends
unlessthereisanemergency.
GeneralInformation
Thetotalcostforthecampis$50.Thisdoesnotincludeanymoneyneededfortraveltoand
fromthecamp,cokes,candy,etc.TherewillbeasnackstandavailableonSaturday.
Whileatcampyourchildwillbeparticipatinginlargegroupworshipsessions,small
groupbiblestudysessions,andmanyrecreationalactivities,allwiththepurposeofteaching
themwhotheyareinChrist.Pleaseprayforyourchildwhiletheyareatcampandbe
preparedtoseeGodworkinyourchildthroughthisexperience!
ThingstoBring
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Bible,Pen,Notebook
SleepingBag/Sheets&Blanket
Pillow
2Towels-1forshower,1forPool
Washcloth
Flipflopsorsandalstogotothepool
1-piecebathingsuit(iftwopiecemusthaveat-shirtoverit)
Toiletries–soap,shampoo,deodorant,toothbrush,toothpaste,etc.
Tennisshoesforallactivitiesexceptpooltime
Modestshorts&tees(thisattireisappropriateforallactivities)
Showershoes
Plastictrashbagfordirtyclothes
Sunscreen
InsectRepellant
FlashLight
Moneyforsnacks
AnExcitedAttitude!
ThingsNOTtoBring
• CellPhones,IPodsorotherelectronicdevices
KidCityCampRules
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Iwillrespectandhonorallworkersandleadersatalltimes.
Iwillgive110%duringallactivities.
IwillbringaBible,pen,andpapertoeveryservice.
Iwillnotteaseanyone.
Iwillnotcomplainorhaveapoorattitude.
Iwillhonor,respect&thankthepeoplewhoarecooking&servingthemeals.
Iwillhonorandrespectallfacilities.
2016KidCitySummerCampSchedule-2nd-3rdGrade
FRIDAY
1:00-Registration&SwimTest(w/parents)
2:15-Snack/Break/Saygood-byetoparents
2:30–KickoffandSession1
3:15-SnackandTraveltogamelocations
3:30-SmallGroup1
4:30-ActivityTime1
5:30-Break/Washupfordinner
5:40-Dinner
6:30–Session2
7:00-SmallGroup2
7:30-FUNEVENT
8:30-HeadtoRooms/Bedtimepreparation
9:15-Lightsout
SATURDAY
7:00-TeamWakeUp
7:30-Wakeupandgetready
8:00-Breakfast
8:30-FirstFruits(QuiettimewithGod)
9:00–Session3
9:50-SmallGroup3
10:50-ActivityTime2
11:50-CleanUpforLunch
12:00-Lunch
12:30-ActivityTime3
2:45-Snackandtraveltodormforpackupandcleanup
3:00-Cleanup/changeoutofwetswimsuits/cleandorms
3:30-HeadHome
2016KidCitySummerCampSchedule-4th-5thGrade
FRIDAY
1:00-Registration&SwimTest(w/parents)
2:15-Snack/Break/Saygood-byetoparents
2:30–KickoffandSession1
3:15-SnackandTraveltogamelocations
3:30–ActivityTime1
4:30-SmallGroup1
5:15-Break/Washupfordinner
5:30-Dinner
6:30–Session2
7:00-SmallGroupBibleStudy2
7:30-FUNEVENT(TBD)
8:30-HeadtoRooms/Bedtimepreparation
9:15-Lightsout
SATURDAY
7:00-TeamWakeUp
7:30-Wakeupandgetready
8:00-Breakfast
8:30-FirstFruits(QuiettimewithGod)
9:00–Session3
9:50–ActivityTime2
10:50-SmallGroup3
11:50-CleanUpforLunch
12:00-Lunch
12:30-ActivityTime3
2:45-Snackandtraveltodormforpackupandcleanup
3:00-Cleanup/changeoutofwetswimsuits/cleandorms
3:30-HeadHome
DirectionstoPlainsBaptistCampground
DirectionstoPBCFromAmarillo:
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TakeI-27SouthtoPlainview.
Takeexit53forI-27Business,Plainview.
KeepleftattheforkandmergeontoI-27BUSS/NColumbiaSt
TurnleftontoUS-70E/W5thStandcontinuetofollowUS-70E
TurnrightontoTX-207S/US-62W/SRallsHwy.
In7.6miles,TurnleftontoCoRd318.
DirectionstoPBCFromPlainview:
• ProceedEastonHwy70toFloydada.
• TurnrightontoTX-207S/US-62W/SRallsHwy.
• In7.6miles,TurnleftontoCoRd318.
DirectionstoPBCFromLubbock:
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ProceedEaston19thstreettowardDixieDrive.
ContinueontoW.StateHwy114E/US62E/IdalouRoad.
ContinuetofollowW.StateHwy114E/US-62E.
TurnleftontoUS-62E.
ContinueontoTX-207N/AvenueE
ContinuetofollowTX-207N
Drive13.3milesandturnrightontoCoRd318.
MedicalRelease
Intheeventofanemergencywheremedicaltreatmentisrequired,Igivepermission
toKidCitySummerCampstafftoobtaintheservicesofalicensedphysician.Please
attempttocontactmeimmediatelyconcerninganysuchemergency.
__________________________
______________________
Signature
Relationship
__________________________________
Child’sName _____________________________
DOB
Insuranceinformation:
Inscompanyname:___________________
InscompanyID#:____________________
Policyholdername:__________________
Allergies:
___________________________________________________________________
_________________________________________
Medicationscurrentlytakingandwillbebringingwiththemtocamp:
___________________________________________________________________
_________________________________________
Emergencycontacts:
Name:_______________________ Relationship:___________________
DayPhone#:_________________ Evening#:_____________________
Name:_______________________ Relationship:___________________
DayPhone#:_________________ Evening#:_____________________
Harvest
christianfellowship
Activity: [
Liability Release
Revision A, 6-13-12
]
2016 Kid City Summer Camp
In consideration of being permitted to participate in the Activity conducted by Harvest
Christian Fellowship, Inc., Plainview, Texas, I, for myself and my legal representatives, heirs
and assigns, hereby release, waive and discharge Harvest Christian Fellowship, Inc., and
_Plains Baptist Assembly
(for housing and projects) its officers, elders, representatives,
employees and members (collectively Harvest and Harvest Christian Fellowship), and each of
them, from all liability to me for any and all loss or damage, and any claim or damages resulting
there from, on account of injury to my person or property, whether caused by the negligence of
, or otherwise while I am involved in the Activity.
Harvest, Plains Baptist Assembly
I hereby assume full responsibility for the risk of bodily injury, death, or property damage due to
the negligence of Harvest, Plains Baptist Assembly
, or otherwise while I am involved in
the Activity.
I hereby expressly agree that this release, waiver and indemnity agreement is intended to be as
broad and inclusive as permitted by the laws of the State of Texas, and that if any portion thereof
is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and
effect.
Signature of Releasor
(parent/guardian if under 18)
Printed Name
Date
WELCOME TO A HARVEST EVENT!
We are excited you chose to attend an event sponsored by Harvest Christian Fellowship where you can share and
enjoy Christian fellowship. In many of our ministry events the Harvest ministry team may pray and give
Christian advice regarding a particular request by a participant. Our team is composed of lay volunteers and
pastors who are not professionally trained or licensed in counseling. We are a church-based ministry
providing guidance and spiritual counseling and deliverance ministries in individual and group settings. Our
team is composed of lay volunteers and pastors who are not licensed counselors, as the state of Texas does not
require such licensing.
Spiritual Counseling Ministry Statement
What You Can Expect of Us: You can expect our ministry team to offer you acceptance, compassion and
love as we provide Biblically based counseling that is within the scope of our ministry.
Biblical Basis: We believe that the Bible provides thorough guidance and instruction for faith and life.
Therefore, our counseling is based on scriptural principles rather than theory of secular psychology or psychiatry.
Neither the pastors not the lay volunteers of Harvest are trained or licensed as
psychotherapists or mental health professionals, nor should they be expected to follow methods of such
specialists.
Not Professional Advice: Some of our lay volunteers work in a professional function outside the church. When
serving an event, volunteers within this ministry do not provide the same kind of professional advice and services
they do in their professional capacities. Therefore, if you have significant legal, financial, medical or other
technical questions, you should seek advice from an independent professional.
Qualification of Lay Event Leadership: Because of the Biblical and Spiritual nature of this ministry, we
instruct our volunteers for a particular event. Lay volunteers do not possess professional licenses or certification
for the practice of professional counseling, marriage, family therapy or social work specialties, nor do they
necessarily possess the required education and expertise on training of such license.
Confidentiality: Under normal circumstances, everything you discuss with a pastor or a lay volunteer will be
held in strict confidence. However, you should be aware there are some situations in which a pastor or lay
volunteer may be required by law to report information to the proper authorities without your permission or
knowledge. These situations include, but are not limited to: A person’s indication of harm to self or others,
involvement in a felony, suicidal intention and/or reasonable evidence of child or elder abuse or neglect. The
pastor or lay volunteer may also disclose information in response to a subpoena issued by a court of law.
Additionally, the pastor or lay volunteer may also disclose information in the event he/she deems it
relevant.
Having clarified the principles and policy for Harvest Event Ministry, We Welcome the opportunity to
minister to you in the Name of Christ and to be used by Him as He helps you to grow in spiritual maturity and
usefulness in His Body. If these guidelines are acceptable to you, please sign below our waiver of liability.
_________________________
Signature of Participant
Date: __________________
________________________
Printed Name
NSC-200PleaseprintClearlyinblackorblueinkandcompleteallinformationonbothpages.
CampAttending:_______________________________________________CampDates:_________________________
CamperInformation
LastName:____________________________FirstName:_________________________DateofBirth:____/____/_____
Address:___________________________________City__________________ST_____Zip_______________Age______
LastGradeCompleted:__________ChurchAttendingCampWith:___________________________________________
ParentInformation
Persontonotifyintheeventofanemergency__________________________________________________________
RelationshiptoCamper________________________HomePhone___________________Cell___________________
AlternatePhone_______________________ParentEmailAddress__________________________________________
AlternateContact______________________________RelationshiptoCamper______________________________
Phone____________________________AlternatePhone_______________________
CamperMedicalHistory
1)KnownAllergies(Drug/Environmental/Food)_______________________________________________________
2)ChronicIllnesses_______________________________________________________________________________
3)Medications(presentlybeingtaken,dosage,andtime)_________________________________________________
4)Datesfortherequiredimmunizationsfollowing(REQUIRED).
Polio_________DPT________Measles________Rubella_______Tetanus_______Dateoflastphysical___/___/_____
5)Medicalconditionsandrestrictions__________________________________________________________________
6)FamilyPhysician_______________________________________________________Phone____________________
7)InsuranceCarrier______________________________________________________Phone____________________
PolicyNumber_________________________________________Address____________________________________
8)Checkallthatapply:Ihaveorhavehad:___HeartProblems ___ChestPains____EpilepsyDiabetes,___Fainting
____Spells/Blackouts____HighBloodPressure__Arthritis/BackProblems___Operations/SeriousIllness
___Disabilities/ChronicRecurringIllness___AllergiestoMeds______________________________________________
9)Additionalcomments/Restrictions____________________________________________________________________
10)GeneralHealthStatement_________________________________________________________________________
*Specialdietsduetomedicalreasons,pleasecontactthecampofficeinadvanceforalternatearrangements*
MedicalRelease
Igivepermissionformedicalpersonneltoadministerthefollowingnon-prescription,overthecountermedicationsas
indicatedbycheckingbelow:
__Acetaminophen__Ibuprofen__Decongestant__Antacid___Antihistamine__AntihistamineCream
__Antibacteria__Ointment__CoughMedicine
AllmedicationsmustbegiventotheCampNurseatregistration.Placetheminalargeziplockbagwithyourchild’s
nameandchurchname.Prescriptionsmustbeintheoriginalcontainerwiththecamper’snameandcurrentdosage.I
givepermissionforCampmedicalpersonneltoadministerprescriptionsandothermedicationsdeemednecessaryfor
routinehealthcare.Intheeventofanemergency,IgivePlainsBaptistAssemblyStafformychurchrepresentative
permissiontoseekmedicalaidformychild.
Camper’sName_______________________________________Print_____________________________________
Parent’sNamePrint____________________________________________________________________________
Parent’sSignature___________________________________________________Date_____________________
NSC100PlainsBaptistCampCamperRegistration CamperName_____________________________
Page1
Church_______________________________________
Parent/GuardianStatementofParticipation,AssumptionofRisk,andReleasefromLiability
1.ACKNOWLEDGEMENTOFINHERENTRISKS
Igive_______________________permissiontoattendPlainsBaptistCampandtoparticipateinscheduledand
unscheduledactivities.Ihavereadandunderstandtherisks,andresponsibilities,andliabilitiesaslistedbelow.Icertify
thatIamawareoftheinherentrisksassociatedwithoutdoorcampactivitiesaswellastheinherentrisksofbeingon
campproperty.Notwithstanding,Iherebygivemychild/wardpermissiontoparticipateinallcampactivities.Camp
activitiesmayincludebutarenotlimitedto:hiking,climbing,running,swimming,ropescourses,fieldsports,waterfront
recreation,andshootingsports.Further,inconsiderationforPlainsBaptistCampagreeingtoaccepttheafore
mentionedchild/individualasacamper/guest,Iherebypersonallyassumeallrisksinconnectionwithmychild’s
attendanceandparticipationintheeventsatPlainsBaptistCamp.
2.ACKNOWLEDGMENTOFFINANCIALRESPONSIBILITY
Intheeventthatmychildisinjuredoncamppropertyorduringcampactivities,IacknowledgethatIshallbepersonally
liablefor,andagreetopay,allcostsandassociatedexpensesincurredinconnectionwithmedicaland/ordentalservices
renderedtomychildinresponsetosaidinjury.
3.LIMITATIONSONINSURANCECOVERAGE
Iunderstandthatmypersonalinsurancecoveragewillbetheprimarycoverage.Onlylimitedsecondaryaccidentand
illnesscoverageisprovidedbyPlainsBaptistCampforhealthcareneeds,suchasdoctorofficevisits,hospitalemergency
roomvisits,orambulance/medi-flightservices.Iacknowledgethatclaimstobesubmittedundersuchcoveragearetime
sensitive,andmustbefiledwithin30daysofthedateofinjury.Iagreetothereleaseofanyrecordsnecessaryfor
treatment,referral,billingorinsurancepurposes.
4.RELEASEANDHOLDHARMLESSAGREEMENT
IagreetoreleaseandholdharmlessPlainsBaptistCamp,itstrustees,employees,agentsandrepresentativesforany
injury,harm,orotherdamagebyanyoccurrenceinconnectionwithmychild’sparticipationincampactivitiesinany
formorfashion.IfurtheragreetoreleaseandholdharmlessPlainsBaptistCamp,it’strustees,employees,agentsand
representativesfromanyclaimbyme,ormyfamily,estate,heirs,orassignsoutmychild’sparticipationinactivitiesat
PlainsBaptistCamp.
5.PRE-AUTHORIZEFORMEDICALTREATMENT
Aspreviouslylisted,Iauthorizeanymedicaland/orsurgicaltreatment,includingbutnotlimitedtohospitalcare,tobe
renderedtomychild,asneededinthejudgmentofthetreatingphysician,whoischosenbytheCampDirector,ora
designatedrepresentativeworkingunderhim,ascircumstancesrequire.IfurtherauthorizePlainsBaptistCampStaffto
renderfirst-aidandtoadministermedicationsasprescribedandreceivedbytheCampNurseatregistration.
6.ACKNOWLEDGMENTOFRESPONSIBILITYFORDAMAGES
IagreethatIamfinanciallyresponsibleforanydamagetocamppropertycausedbymychild,includinggraffiti.
7.CONSENTTOADDRESSDISCIPLINARYPROBLEMS
Theaforementionedcamperagreestoobeyallcamprules,andtofullycooperatewiththeadultleadership,campstaff,
andothercampers.Iagreethatifinthejudgementoftheadultleadershiporcampstaffmychildbecomesadiscipline
problem,mychildmaybesenthome,atmyexpense,andthatIwillforfeitallcampfeespaid.
8.USEOFCHILD’SPHOTOGRAPHFORPROMOTIONALPURPOSES
Iagreeandconsentthatmychild’sphotographmaybeusedforpromotionalpurposesorpublicitymaterialbyPlains
BaptistCamp.IacknowledgethatIamtheparent/guardianofabovenamedchild.Bymysignaturebelow,Iacknowledge
thatIhavereadandunderstandtheinformationsetforthabove,includingthereleaseandholdharmlessagreement.
__________________________________________________________________Date_________________
Parent/GuardianSignature_____________________________________________Date__________________
PlainsBaptistCamp
CamperRegistration
Page2
Parents/Legal Guardians:
Plains Baptist Camp has permission to put a colored wrist band on my child to identify allergies or a medical condition such as diabetes
or asthma etc. This will help alert camp staff of medical conditions in the event of a medical emergency.
Parent /Legal Guardian______________________________________________ Date________________
Print Name
Signatue__________________________________________________________ Date_______________
Camper______________________________________________________________________________
Condition/Allergies______________________________________________________________________
Thank you for allowing Plains Baptist Camp the opportunity to serve you.
MED300
MedicationForm
Forthesafetyofeachcamper,allmedication,prescriptionornon-prescriptiondrugswillbeheldatthecampnurse’s
stationandadministeredbycamp-approved,certifiedmedicalpersonnel,whoareonduty24hoursaday.
Ifyouneedtosendmedicationtocamp,pleaseputitalongwiththecompletedformbelowinazip-lockbag.PleaseDO
NOTsendanymedicationthatisnotabsolutelynecessary.
ØAllmedicationmustbeinitsoriginalcontainersfromthepharmacy.Noblankpillbottlesordailymedicationboxes.Be
suretomaketheformvisibleinthebag.
_____________
PUTTHISFORMINTHEZIP-LOCKBAGALONGWITHTHEMEDICINE
THISMEDICATIONBELONGSTO______________________________________________
CAMPER’SCHURCH______________________________________________________
DOSAGE_____________________________________________________________
___________________________________________________________________
PARENT’SNAME________________________________________________________
DAYPHONE______________________NIGHTPHONE_________________________
DOCTOR’SNAME_______________________________________________________
DOCTOR’SPHONE______________________________________________________