Preteen: July 4-7 - American Fellowship Cowboy Churches

2015 CENTRAL TEXAS
COWBOY CAMPS
Latham Springs Camp & Retreat Center
Aquilla, Texas
Youth: June 30- July 3
Preteen: July 4-7
AFCC // P O Box 513 // Waxahachie, Texas 75168
phone 972-937-9979 // fax 972-937-9943 // www.americanfcc.org
DEADLINES
APRIL 1, 2015
Postmark deadline for Advance Registration Form and deposit in the amount of
$50 per camper (a deposit may be transferred to a new camper, but not
refunded); mail to
AFCC
P O Box 513
Waxahachie TX 75168
May 1, 2015
Deadline for Criminal and Sexual Misconduct Records Check Authorization form
(for each sponsor) and Church Registration form to be mailed, faxed or emailed
Fax # 903-842-2828
Email [email protected]
MAY 1, 2015
Postmark deadline for full payment in advance at the discounted rate of $185 per
camper; NO REFUNDS ALLOWED AT THIS RATE; mail to
AFCC
P O Box 513
Waxahachie TX 75168
TWO WEEKS PRIOR TO CAMP
All adds, drops, and changes to the original Church Registration form must be
faxed or emailed to Connie
Fax # 903-842-2828
Email [email protected]
CAMP DAY
Final payment at the rate of $200 per camper due at camp
--------------------------------------------------------------------------You may pay for some of your campers at the discounted rate and the remaining
campers when you arrive at camp.
For example: You have 30 campers/sponsors preregistered ($50 deposit paid for
each). You feel confident that 25 of those will be at camp, so you pay for those
campers at the discounted rate of $185 each by May 1. Youʼre not sure about
the remaining 5 campers, so you pay for those campers at the full rate of $200
each when you arrive at camp.
FEBRUARY
1. PRAY
THE PROCESS STEP-BY-STEP
2. Find a member of your team that is a good organizer and GET SOME HELP
3. Create and copy a “camp packet” for each camper
Cover sheet with this info (run this on colored paper):
Camp location and dates
Camp fee (you may want to add a transportation cost to the camp cost)
Your name and contact information
Due dates for forms & payments (leave yourself a few days to organize paperwork)
Place and time to meet the morning you leave for camp
Time you expect to return from camp
Then, add these forms from this registration packet:
Camper Rules and Information & Photo & Email Info (run this on colored paper)
Camper Registration form (run this on white paper)
Food Allergies and Medication forms (run this on white paper)
***When you staple your camp packets together, make sure the Camper Registration
form and Medication form are at the back of the packet. That way, you can remove
those forms and the parents can keep and use the colored information pages.
Follow the same steps for your sponsor packets. Replace the Camper Registration
form with the Sponsor Registration form and add the Criminal and Sexual
Misconduct Records Check Author. form. Don’t forget Allergies & Medication.
4. Promote camp
Show 2014 camp video and/or share student testimonies about camp
5. Make a list of potential campers and sponsors
6. Begin collecting campers’ deposits and registration forms and don’t forget to check
for parent and student signatures; then keep a record of deposits and forms
MARCH
1. PRAY
2. Continue promoting camp and collecting deposits and forms
3. Complete the Advance Registration form and mail it and your deposit to AFCC,
P O Box 513, Waxahachie TX 75168. This form must be postmarked by April 1, 2015
in order to guarantee your church a spot at the camp of your choice.
APRIL 1
POSTMARK DATE FOR ADVANCE REGISTRATION FORMS THAT GUARANTEE
YOUR CHURCH A SPOT AT THE CAMP OF YOUR CHOICE
APRIL
1. KEEP PRAYING
2. Continue collecting camp payments and forms
3. Verify that each sponsor has completed and signed a Criminal and Sexual
Misconduct Records Check Authorization form.
4. Fax or email the Criminal and Sexual Misconduct Records Check Authorization
form for EVERY SPONSOR and the Church Registration Form by May 1, 2015.
Fax # 903-842-2828
Email [email protected]
After May 1st you may only replace a boy with another boy or a girl with another girl. A
fifty dollar ($50.00) non-refundable deposit is required for each person. This is a good
time to start a list of students that may want to come to camp, but did not meet the signup deadline and a list of students that signed up, but are unable to come.
MAY 1
POSTMARK DATE FOR FULL PAYMENT AT THE DISCOUNTED RATE OF $185 PER
CAMPER; CHURCH REGISTRATION FORM AND CRIMINAL RECORDS CHECK
FORMS DUE
MAY
1. KEEP PRAYING
2. Continue collecting camp payments and forms
JUNE
1. KEEP PRAYING
2. Fax or email all adds, drops, and changes two weeks before camp to Connie
Fax # 903-842-2828
Email [email protected]
3. Check the camper and sponsor registration forms for signatures (both camper and
parent/guardian).
4. Make one copy (for you) of the completed forms.
5. Make sure each sponsor has completed the Child Protection Training course.
Training is available at lathamsprings.com. If you need assistance with this training,
please contact Connie.
6. Collect all money and bring one check from your church with the total amount owed.
BRING TO CAMP
1. Individual Registration forms for all campers and sponsors (original for camp; copy for
you) and a copy (for camp) of each sponsorʼs Child Protection Training certificate
2. Prescription medicines in original containers
3. Your final camp payment
4. STUDENTS AND SPONSORS READY FOR A GREAT TIME FILLED WITH LEARNING
ADDITIONAL INFORMATION
All forms may be downloaded from the AFCC Website at www.americanfcc.org. Be sure
that you use the camp forms for the specific camp you plan to attend as forms are
different for each camp.
AFCC address: "
"
"
"
"
"
"
"
"
American Fellowship of Cowboy Churches
PO Box 513,
Waxahachie TX 75168
Phone contact: "
Connie Sanford, 903-571-7119
Fax number:"
903-842-2828 (for camp only)
"
Email address: ""
[email protected]
Requirements for all Sponsors
You must have at least one adult sponsor for every ten students of each gender. If you bring
fewer than ten students of each gender, you still MUST bring one sponsor for each gender.
For example: if you bring six girls and seven boys you must bring one female sponsor and one
male sponsor. If you bring 16 girls and 23 boys, you must bring two female sponsors and
three male sponsors.
Must be 21 or older
Must complete the Criminal and Sexual Misconduct Records Check Authorization form
(by May 1st)
Must complete the Child Protection Training Course for the camp you will be attending.
Have your pastor or church staff member sign all sponsor forms where required.
Keep the original Certificate of Completion on file at your church and bring a copy to camp.
CENTRAL TEXAS CAMP
Latham Springs Camp & Retreat Center
Aquilla, Texas
CAMP CHECK IN and CHECK OUT TIMES
Preteen Camp (3rd-6th grades)
Check in on July 4th from 9:00 a.m. until 12:00 p.m.
Check out and leave on July 7th at appx. 9:00 a.m.
Youth Camp (7th-12th grades)
Check in on June 30th from 9:00 a.m. until 12:00 p.m.
Check out and leave on July 3rd at appx. 9:00 a.m.
CAMPER RULES AND INFORMATION
Wha’cha Need to Bring
PLEASE LABEL ALL ITEMS (FIRST AND LAST NAME)
Bible
notebook
pens or pencils
sleeping bag or twin sheets and blanket
pillow
toothpaste/toothbrush
soap/shampoo/hairbrush
shower shoes (flip-flops)
towels/washcloths
sunscreen and/or a cap or hat
insect repellent
shorts and/or jeans (may get muddy)
shirts/underwear/socks (may get muddy)
comfortable tennis shoes or boots
modest swimsuit
plastic bag for dirty clothes
medication (in original prescription bottle; to be
dispensed by the camp nurse)
flashlight
spending money for snacks and souvenirs
(appx $20.00)
snacks in single-serving size or reclosable
bags
camera to capture the fun
DO NOT BRING
excessive money
expensive jewelry
electronic games
weapons
Wha’cha Can an’ Can’t Wear
This Dress Code applies to all students and sponsors attending AFCC Cowboy Camps
and will be enforced by camp staff and host camp staff. Remember, AFCC camps are
Christian camps and we should seek to represent Jesus Christ in every aspect of the camp
experience including the way we dress.
Dress Code
★ Shorts must be modest in length. No short shorts.
★ All pants, jeans, shorts must have waistbands.
★ Shirts must cover the entire torso and not allow midriffs or bellybuttons to show even
when arms are raised.
★ Sleeveless shirts are allowed but must cover the entire shoulder.
★ No spaghetti straps or tank tops.
★ Swimsuits must be modest.
★ Undergarments must be worn underneath clothing and cannot show through clothing or
rise above the waistband of pants.
★ All clothing must be appropriate and cannot advertise any alcohol or tobacco products.
★ Clothing that represents things contrary to Christianity (i.e. satanic shirts, shirts with
inappropriate language, etc.) cannot be worn.
★ Sleep wear must be modest and may not be worn out of the cabins.
★ All campers are to be fully dressed in accordance with the dress code any time they are
outside their cabins.
Wha’cha Can an’ Can’t Wear, cont.
Enforcement of Dress Code
Group leaders are asked to review the dress code with all campers and their parents
before leaving for camp. We ask that group leaders and adult sponsors lead by example in
following the dress code.
Wha’cha Can an’ Can’t Do
AFCC Cowboy Camps are Christian camps, and all rules are designed to help us conduct
ourselves in ways that reflect Christ in all we do.
★ Alcohol, illegal drugs, tobacco, knives, guns, pets, skateboards, fireworks, or MP3
players ARE NOT PERMITTED. Such items will be confiscated and may be returned
at departure.
★ Cell phone usage is permitted only during free time or in case of emergency.
★ Please respect all camp properties. We ask you to assist in keeping the grounds clean
of trash. Cans are provided.
★ If property or equipment is damaged, your group will be held responsible for any cost
incurred for repair or replacement.
★ If the dorm room is excessively filthy during your stay or upon departure, your
church will be assessed a fine of $100.00.
★ Shaving cream fights, water fights, etc. will not be tolerated.
★ All clothing must meet dress code.
★ Shoes must be worn at all times unless the camper is in the swimming pool.
★ All Camp activities are closed unless camp staff is present.
★ Meals must be eaten in the dining hall unless otherwise prearranged with camp staff.
★ Students are not allowed to leave the camp grounds while attending Cowboy Camp.
★ Students must attend scheduled activities.
★ Students are not allowed to enter the dorms of the opposite sex for ANY reason.
★ PDA (Public Display of Affection) will not be tolerated.
★ Students are not allowed to share any medication belonging to them with any other
student—all medication must be checked in with the camp nurse.
★ Students are not allowed to ride livestock and/or tend to livestock without camp staff
present.
For emergencies please call:
Central Camp: Latham Springs Camp & Retreat Center (254-694-3689)
Appendix 21
Stay in touch this summer with Online Photos & Camper Email!
We are excited to tell you about our partnership with Bunk1.com! Bunk1’s secure, easy to use website
services let you stay in touch with your camper all summer!
Returning Parents: If you had an account at this camp last summer, you can continue to use your old username and
password. Simply sign in at the link below. The first time you visit the site, you will be prompted to update your contact
information and re-activate your account.
Let’s Get Started!
To set up a new account and visit our Online Community:
1. Go to our website at www.lathamsprings.com
2. Click the flashing “Camp Photos / Camper Email” button.*
3. Click “Register Now”
4. Enter your Pre-Approved Registration Code
(This will be communicated to Camp Directors in the spring who will distribute the information to parents).
5. Fill out all the required information
6. Purchase Bunk Note credits (you will need a credit card)
7. View camper pictures and send an email to your camper!
** For your camper’s safety, please do not share the Pre-Approved Registration code.
FREQUENTLY ASKED QUESTIONS
How do I view pictures?
Follow the instructions above except, after registering, simply sign in and click on the Photo Gallery button. Photos are kept in
folders found on the left side of the page below the words “Image Folders”. Click on any folder to see the pictures within that
folder. You can even purchase prints or other photo gifts (e.g., t-shirts, mugs) of your favorite pictures! There is no cost to view
pictures.
How do I send a Bunk Note (one-way email) to my camper?
Follow the instructions above except, after registering, simply sign in and click on the Bunk Notes button. Enter your camper’s
name, select the correct cabin, type your message, and hit the “Send” button. **Because there will be 400-900 campers in
attendance each week, please type the name of the camp session AND the church name in the subject or in the beginning of your
message. This will help ensure that your email makes it into the correct hands to be distributed.
When will my camper receive their email?
When you send an email, the message will appear in the camp office’s email at midnight the day it was sent. The camp office will
print the messages, and give them to the camp director to be distributed to the campers. PLEASE NOTE: If you send a message for
your camper on their last day of camp before they depart, they will not receive it. Again, this is because the message does not
appear for print until midnight the day the message is sent.
Can other relatives use these services?
Certainly. Once you have set up your account, you will be able to invite other people to access these services.
Why do I have to pay to send Bunk Notes (one-way email)?
Each morning, the Bunk Notes system bundles and sorts the messages for us to print out and distribute to campers. It also protects
us from computer viruses and allows us to easily manage these emails. Your payment helps to cover the cost of the system, paper,
ink, and labor and, more importantly, frees us to do what we do best – be with your kids! Bunk Note credits cost $1 each and are
purchased in packs of various sizes.
What do I do if I lost my username and password?
You can get it online by going to www.Bunk1.com and clicking on the link “Lost Your Password?” (to the left of the page below the
sign in button). You will receive an email with your username and password within a few minutes.
QUESTIONS OR PROBLEMS?
Please call Bunk1 at 1-800-216-9472 or go to www.bunk1.com/contact.asp
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2015 CENTRAL TEXAS
COWBOY CAMPS
Latham Springs Camp & Retreat Center
Aquilla, Texas
Youth: June 30- July 3
Preteen: July 4-7
Registration Fees
• To reserve bunks at the camp of your choice, a $50.00 deposit per student and
sponsor is due with this Advance Registration Form
• A deposit may be transferred to a new camper if a camper backs out, but there will
be no refund issued once a deposit is paid.
• Cost $185 for each person paid in full by May 1, 2015 (NO REFUNDS)
• Cost $200 for each person paid in full on the first day of camp
Packet Information
Registration Packets can be found on our website: americanfcc.org
Mail a separate form for each camp and your deposit by April 1, 2015
Number of
Sponsors
+
Number of
Students
=
Total Campers
x
Deposit per
Camper
$50.00
=
DEPOSIT DUE
circle CENTRAL CAMP attending
PRETEEN
YOUTH
Contact ___________________________________________________________________________________________________
Phone _____________________________________________ Email __________________________________________________
Church Name _______________________________________ Pastor__________________________________________________
Church Address _____________________________________ City/State/Zip ____________________________________________
AFCC // P O Box 513 // Waxahachie, Texas 75168
phone 972-937-9979 // fax 972-937-9943 // www.americanfcc.org
Criminal & Sexual Misconduct
Records Check Authorization Form
AFCC Camp you will be attending:
Central Texas Camp
DUE BY MAY 1, 2015
Preteen_____ Youth_____
LAST NAME
THIS FORM IS REQUIRED EACH
YEAR FOR EACH SPONSOR
FIRST NAME
MIDDLE NAME
DATE OF BIRTH
SOCIAL SECURITY
DRIVER’S LICENSE
STREET NUMBER
STREET NAME (NO PO BOXES)
APARTMENT NUMBER
CITY
STATE
ZIP
PHONE NUMBER
NAME OF CHURCH
By signing this form I authorize Latham Springs Camp & Retreat Center and/or the American Fellowship
of Cowboy Churches (AFCC), their staff, and/or volunteers to make an independent investigation of my
background, references, character, criminal or police records to obtain information which may or may not
qualify me as a volunteer at any AFCC Cowboy Camp.
SIGNATURE
DATE
Child Protection Policy (the training is valid for two years)
I have proctored a State of Texas approved Child Protection Training Course for the above-named AFCC
Cowboy Camp sponsor applicant. The above applicant scored a grade above 80 on the final exam.
Therefore, I have issued this sponsor applicant a 2015 Certificate of Completion. A copy of this Certificate
will be brought to camp and will be readily available upon request. Child Protection Training is
available online at www.lathamsprings.com.
Check One:
I will provide a copy of the 2014 or 2015 Certificate of Completion
No copy of 2014 Certificate of Completion, but sponsor took the training provided by AFCC Camp
attended last year
Church Group Leader Signature__________________________________________ Date ____________
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Central Texas Camp
Church Registration Form
Church Name, City ______________________________________________
Please send a separate form for each camp
Check one: Preteen: July 4-7 ___ Youth: June 30- July 3 ___
Camper or Sponsor Name
(please list all campers first;
make copies as needed)
Male
Camper
***For changes made after the ORIGINAL
REGISTRATION FORM has been mailed,
please indicate the type of change in the
last column below and resend the form.***
Female
Camper
Male
Sponsor
Female
Sponsor
T-Shirt Size
(state youth or
adult size)
Correction,
Addition or
Deletion
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
TOTALS (on 1st page only for all pages)
TOTAL CAMPERS AND SPONSORS ATTENDING CAMP ____________
T-shirt Order:
youth med _______ youth lg _______ youth xlg _______
adult sm _______ adult med _______ adult lg _______ adult xlg _______ adult 2X _______ adult 3x ______ adult 4x ______
Name of Church:_____________________________________
Name of Camp Session: _______________________ Date of Camp: _______________
Camper Registration/Medical & Risk Release Form
Latham Springs Camp & Retreat Center
(under 18 years of age)
Camper’s Name____________________________________
Address________________________City_______________ST____Zip____________
Birthdate____/____/____
By the time I get to camp, I will have completed ________ grade!
T shirt size __________
Gender:  Male  Female
Are you a Christian?:_____________ Church member?______________ Church:__________________________________
Parent's/Legal Guardian’s Name:________________________________________________ Relation_____________________________________
Home Phone (_____)__________________________ Work Phone (_____)______________________ Email______________________________
Dr.’s Name:________________________________________ Ph #:___________________________________________
IMMUNIZATIONS: Date of last Tetanus shot (if known)________ Allergic to a Tetanus booster? _______ Immunizations up to date? ________
Health History-List any recent illnesses, injuries, any allergies, and/or hospitalizations relevant to a physician in case of an emergency (attach extra
sheet if necessary) __________________________________________________________________________________________________
Age____________ Height____________ Weight__________ Allergies:_________________________________________________
If your child has food allergies or special nutritional needs, please complete FOOD ALLERGY & SPECIAL DIETARY NEED form and fax to
254.694.4174, then contact the Food Service Director (Cecil Rogers, 254.694.3689) at least two weeks prior to camp dates.
*All medications must be given to the Camp Nurse. Place them in a large Ziploc bag with your child’s name and church name. Prescriptions must
be in the original container with the camper’s name and the current dosage. No medications will be given unless they are in original containers per
Texas Department of State Health Services. If your child/youth requires an asthma inhaler or antidote for insect bite or allergies (prescribed by
doctor) have them bring at least two (2) to camp. The medication must be registered with Camp Nurse. One (1) will be kept and closely guarded by
camper and one (1) given to the Camp Nurse. Similar special cases must be discussed with Camp Nurse. If the need arises, I give my permission for
my child/youth to be inspected for head lice/eggs. I understand any such check would be conducted sensitively. I understand Latham Springs’
Notice of Privacy Practices uses and disclose health information about my child/youth to the group leader, director, his designee, the child’s sponsor
and medical staff, when in its sole discretion, believes such communication to be in the best interest of my child for treatment, to obtain payment for
treatment, administrative purposes and to evaluate the quality of care that he/she receives. I agree to the release of any records necessary for
treatment, referral, billing or insurance purposes.
I hereby authorize the Latham Springs Camp & Retreat Center staff, Camp Nurse or Group Leadership to make emergency medical decisions for my
child/youth and I understand that my insurance coverage will be primary coverage.
Insurance provider_____________________________________________Policy #__________________
ID#_________________________________
If parent cannot be reached in an emergency, please contact:
Name______________________________________ Phone #_____________________ Relationship_________________
Name______________________________________ Phone #_____________________ Relationship_________________
Name of Medication
Dosage
Frequency / Time(s)
Comments
Camper Pick up Policy: Remember that the continuity of the camp experience is used by the Holy Spirit to touch campers’ hearts.
Taking a camper out for even a brief period can reduce the spiritual effectiveness of camp. Please minimize absences.
Written permission must be provided to the camp before a child will be allowed to leave with any person other than listed below.
Authorized Person’s Name (please write legibly)
Relationship to Camper
Phone Number(s)
List here any activities you or your parents do not want you to participate in. Parents, be sure to notify sponsors of this request.
** Parent & Camper Must Sign on Page 2 **
Page 1
ASSUMPTION OF RISK AND RELEASE OF LIABILITY
Definitions:
“CAMP” means LATHAM SPRINGS BAPTIST CAMP, INC. or LATHAM SPRINGS CAMP & RETREAT CENTER, INC., a Texas nonprofit corporation, its
Member Churches, Directors, Officers, Employees, Agents, Volunteers, or Associates.
“Applicant” means campers and all participants in CAMP activities, and the parent, legal guardian or conservator of any campers and all participants in
CAMP activities, who verifies by this signature that he or she has the legal right to sign on behalf of camper or participant less than 18 years of
age (Minor), and Applicant’s heirs, executors and administrators, successors and assigns, and members of Applicant’s family, including any minors
accompanying Applicant.
“Risks and Dangers” include, but are not limited to, the negligence or intentional acts of other people, including other campers, drowning or other water
injury, falls or injury from heights (ground to 50 feet), accident or illness in remote places without medical facilities, the forces of nature, and travel by air,
boat, automobile, or other conveyance, elements of nature, including temperature extremes, inclement weather, poisonous plants, biting or stinging insects,
animals, rough outdoor terrain, and possibly high altitude, including the possibility of asthmatic or allergic attack.
CONSIDERATION:
Applicant is a camper at CAMP, or potential participant in CAMP Activities. This agreement is made in consideration of CAMP leaders allowing Applicant
to participate in such activities: All Applicants must sign this agreement before being allowed to participate in CAMP activities.
NOTICE:
Applicant acknowledges that these Activities involve inherent Risks and Dangers and that Applicant will be exposed to these Risks and Dangers. Applicant
recognizes that these Risks and Dangers may cause personal injury or death, loss or damage to personal property, emotional distress, and psychological
damage due to accidents or intentional acts which may occur during these activities. Applicant understands that transportation for medical treatment may
take an hour.
APPLICANT’S HEALTH:
Applicant certifies Applicant is completely physically, mentally, psychologically, and emotionally healthy, and capable of participating in all Activities, except
for those listed below. Applicant has specified in detail any reasonable accommodation necessary for any disability that Applicant may have and has
supplied equipment, medicine, or medical supplies that Applicant may need. Applicant understands that participation in this CAMP program is entirely
VOLUNTARY. Applicant is solely responsible for determining whether there is any reason that Applicant should not participate in any Activities, including
possible contact with any substances that may cause asthma or allergic reactions.
RELEASE:
In consideration of, and as part payment for the right to participate in Activities and the services and food arranged by CAMP, Applicant: (1) fully releases
CAMP from current or future liability from negligence, gross negligence, or intentional tort by any person, (2) assumes all Risks and Dangers, whether or
not that risk is foreseeable, and (3) will indemnify and hold CAMP harmless from any and all claims, liability, actions, causes of action, debts, claims and
demands of every kind and nature whatsoever, for personal injury, property damage or loss, psychological injury or emotional distress, or medical expenses
of any kind and attorney’s fees and costs of court filed by Applicant, or by other parties against CAMP, connected with Applicant’s program or participation
in any activities at CAMP or arranged by the CAMP.
Applicant hereby agrees that Applicant will not sue CAMP for personal or property injury, and, if Applicant attempts to sue, Applicant will not
collect any money. In addition, Applicant will indemnify CAMP for attorney’s fees and costs of court fees associated with any litigation against
CAMP connected with Applicant’s program or participation in any activities at CAMP or arranged by the CAMP.
SAFETY:
Applicant will wear shoes and socks and bring and apply sunscreen as necessary. Applicants who are minors or with youth groups will not leave the
CAMP grounds, authorized areas, or vehicles transporting Applicant at any time without permission, and Applicant agrees that CAMP is not responsible if
Applicant violates this rule. Applicant agrees to follow all safety instructions and to use caution to protect Applicant, other camper, CAMP personnel, and
others. Applicant understands that failure to obey safety rules will cause expulsion from CAMP.
Camper Statement: I agree to obey all rules (rules having to do with safety and Christian behavior) and regulations of Latham Springs Camp &
Retreat Center, and will cooperate with leaders and fellow campers and with the camp staff at Latham Springs.
Family Authorization for camper: In consideration for your agreeing to accept the above-named individual as a camper, I/we hereby assume
all risk in connection with participation in the above-named Christian camp. I/We authorize medical and surgical treatment for my child as may be
needed in the judgment of the treating physician (physician chosen by Latham Springs management). I/We understand twenty-four-hour first aid
care is available on the campgrounds, and I authorize transportation of my child at their discretion in case of emergency. I/We further understand
that only limited secondary accident coverage ($2,500 maximum) is provided. I further give permission and consent to Latham Springs Camp &
Retreat Center for any photographs, videotapes and interviews to be taken during the camping session to be published and used to illustrate, report,
promote and advertise the camp including on Internet Web Sites promoting or reporting on the camp. I hereby assign full copyright of these
photographs to Latham Springs Camp & Retreat Center with the reproduction either wholly or in part.
BY MY SIGNATURE BELOW, I VERIFY THAT I HAVE READ AND UNDERSTAND EVERY PROVISION OF THIS AGREEMENT.
Name of Camper
(Please Print)
SIGNATURE of Camper
Date of Signature ___________________________________
Date of Signature ___________________________________
SIGNATURE of PARENT, GUARDIAN or CONSERVATOR,
of minor CAMPER or PARTICIPANT, who verifies by this
signature the legal right to sign on behalf of minor.
Page 2 of 2
Rev 11-04-14
FOOD ALLERGY & SPECIAL DIETARY NEED
Appendix 6
Please Use Separate Page for Each Person
Fax Completed Form to 254.694.4174 Two Weeks Prior to Arrival
Name of Camp: ______________________________ Dates: _________________________
Camper Name: ______________________________ Age: _____________
Church: ______________________________________________________
Parents Name: ____________________________ Phone #: ___________________________
Is parent attending camp with child? ________,
If not, please list name of adult sponsor ___________________________________________
List allergies or explain special dietary needs:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Is camper aware of his/her allergies? ______
Is camper able to monitor his/her own food requirements? _______
Is child bringing some of his/her own food? ________ if so please list below:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
A special place is designated in the kitchen for camper to keep his/her own food.
Latham Springs understands about cross contamination and will make every effort to prevent
any problems. We will strive to work with child and parents to make their week a great dining
experience. Please feel free to call Cecil Rogers, Food Service Director, to discuss any needs or
questions you may have. He can be reached 254.694.3689 ext. 25 or [email protected]
MEDICATION FORM
For the safety of each camper, all medication (prescription or non-prescription drugs)
will be held at the camp nurse’s station and administered by camp-approved, certified
medical personnel who are on duty 24 hours a day.
If you need to send medication to camp, please place it and the completed form below
in a zip-lock bag. Please DO NOT send any medication that is not absolutely
necessary.
EACH MEDICATION MUST BE IN ITS ORIGINAL CONTAINER FROM THE
PHARMACY. NO BLANK PILL BOTTLES OR DAILY MEDICATION BOXES. BE
SURE TO MAKE THE FORM VISIBLE IN THE BAG.
PLACE THIS FORM IN THE ZIP-LOCK BAG
ALONG WITH THE MEDICINE
THIS MEDICINE BELONGS TO ___________________________________________
CAMPER’S CHURCH ___________________________________________________
MEDICINE ____________________________ DOSAGE _______________________
MEDICINE ____________________________ DOSAGE _______________________
MEDICINE ____________________________ DOSAGE _______________________
MEDICINE ____________________________ DOSAGE _______________________
MEDICINE ____________________________ DOSAGE _______________________
PARENT’S NAME ______________________________________________________
DAY PHONE ______________________NIGHT PHONE _______________________
DOCTOR’S NAME _______________________ PHONE _______________________
Name of Church you are representing ________________________________________________________
Name of Camp Session attending _______________________________ Date of Camp ________________
T-shirt
Size
_____
Adult / Leader / Sponsor
Registration Agreement & Medical Release Form for Latham Springs Camp & Retreat Center
Texas Health Department Requirement
To be completed by All Camp Attendees including Directors, Sponsors, Pastors, Volunteers, Speakers, Band Members, Rec Team
and anyone over the age of 18 years old that will be staying over-night.
Name________________________________________________ Phone # _____________ Email Address___________________
First
Middle
Last
(Maiden)
Address ________________________________________ City/State __________________________ Zip __________________
Birth Date ________________ Sponsor Age _______ Driver’s License #_______________
Emergency Contact ____________________________________ Relation ____________________Phone ___________________
Family Physician’s Name ______________________________ Work phone ________________ Pager/Cell _________________
Medical conditions and Health History: List any recent illness, injuries and/or hospitalizations relevant to physician in case of an
emergency (attach extra sheet if necessary) ___________________________________________________________
___________________________________________________________________________________________________
AUTHORIZATION FOR BACKGROUND CHECK
In consideration of the receipt and evaluation of this form by Latham Springs Camp & Retreat Center located at 134 PR 223, Aquilla,
Texas 76622, I hereby give my permission to obtain information relating to my criminal history record. I understand that this
information will be used, in part, to determine my eligibility to serve at Latham Springs. I hereby release any individual, church, youth
organization, charity, employer, reference or any other person or organization, including record custodians, both collectively and
individually, from any and all liability for damages of whatever kind or nature which may at any time result to me, my heirs or my
family, on account of compliance or any attempts to comply with this authorization. I waive any right that I may have to inspect any
information provided about me by any person or organization identified by me in this screening form. I understand that I will have an
opportunity to review the criminal history and a procedure is available for clarification, if I dispute the record as received.
I agree to be bound by the Constitution and policies of Latham Springs Camp & Retreat Center and to refrain from unscriptural
conduct in the performance of my services on behalf of the Camp. The basic criteria which have been established by the State of
Texas for conducting youth camps is met or exceeded by Latham Springs Group Leader Handbook requirements and I agree to read
thoroughly and adhere to all guidelines therein.
RISK RELEASE:
In consideration of, and as part payment for the right to participate in Activities and the services and food arranged by CAMP, Applicant:
(1) fully releases CAMP from current or future liability from negligence, gross negligence, or intentional tort by any person, (2) assumes
all Risks and Dangers, whether or not that risk is foreseeable, and (3) will indemnify and hold CAMP harmless from any and all claims,
liability, actions, causes of action, debts, claims and demands of every kind and nature whatsoever, for personal injury, property
damage or loss, psychological injury or emotional distress, or medical expenses of any kind and attorney’s fees and costs of court filed
by Applicant, or by other parties against CAMP, connected with Applicant’s program or participation in any activities at CAMP or
arranged by the CAMP.
Applicant hereby agrees that Applicant will not sue CAMP for personal or property injury, and, if Applicant attempts to sue,
Applicant will not collect any money. In addition, Applicant will indemnify CAMP for attorney’s fees and costs of court fees
associated with any litigation against CAMP connected with Applicant’s program or participation in any activities at CAMP or
arranged by the CAMP.
REPRODUCED IMAGES
I authorize and release the use of Applicant’s image to be reproduced in any form including, but not limited to, newspapers,
photographs, magazines, and internet websites, to CAMP for any purpose of CAMP.
BY MY SIGNATURE BELOW, I VERIFY THAT I HAVE READ AND UNDERSTAND EVERY PROVISION OF THIS AGREEMENT.
Name of Adult Participant (Please Print)
SIGNATURE of Adult Participant
Date ___________________________________