Children’s Ministries 2014 Southwest Indiana District Children’s Camp Application

Children’s Ministries
2014 Southwest Indiana District Children’s Camp Application
Checklist
All applications must be accompanied by a local church check or money order
No Personal Checks
1st - 6th Grade Camp
Early Registration $205 - $100 received before 5/16 & Ending balance $105.
Late Registration $225 - $110 received after & Ending balance $115.
Total ______________
*Cost
includes snack shack card & t-shirt
It is vital that we receive applications as soon as possible so that we can insure that we have
enough counselors to care for the children, t-shirts for each camper, and enough supplies for
games, crafts, etc. LATE REGISTRATION CAMPERS WILL NOT RECEIVE A CAMP T-SHIRT.
Refunds in cases of emergency only & by discretion of the Camp & District Children’s directors.
Local Church Responsibility
Please make every effort to mail together all individual applications from your local church.
Please review all applications to make sure they are filled out completely.
Make out check or money order payable to: SWID
Mail completed applications and payments to Camp Registrar:
Ashlea Davis
Terra Haute First Church of the Nazarene
801 Fort Harrison Road
Terra Haute, IN 47804-1151
[email protected]
What to bring: Bible, twin size bedding or sleeping bag, swimsuit (no bikinis), flashlight, towels,
toiletries, deodorant, jacket, and any necessary medications.
What NOT to bring: Electronic devices (cell phones, iPods, electronic games, radios, etc…)
water guns, shaving cream, skate boards, roller blades.
Keep this page for your records
2014 Southwest Indiana District Children’s Camp Application
Personal Information
Grade Completed Spring 2014: 1st 2nd 3rd 4th 5th 6th
Gender:
Boy
Girl
Camper’s Name: ____________________________________________ Age: ______
Preferred Name: _____________________________________________
Mailing Address: ______________________________ City: ________________ State: ______
Zip:__________ Phone Number ( ) ________________
Parent Email: ______________________________________________________________
Name of Parents/Guardians:
Cell/Work Phone Numbers:
______________________________________
( ) __________________________
_____________________________________
( ) _________________________
SWID Children’s Camp Medical Authorization & Waiver Medical &
Emergency Information
Camper’s Birthday: _____/_____/_____
Height:________ Weight: ________
Insurance Company:_________________________________
1-800 number:________________________________
Policy Number: _____________________________ Group Number:___________________
Current Medication(s): _____________________________________________________
Date of Last Tetanus Shot:
/
/
Permission to give: Tylenol
Advil
Benadryl
Other _____________
(Generic equivalents may be used.)
List any allergies: ______________________________________________
Does your child have seizures?
Yes
No
Date of last occurrence ________________
List any camp activity from which your child should be exempt from participating
in:______________________________________________________________________________
________________________________________________________________________________
_________________________________________________________________Family
Doctor:________________
Doctor’s phone number ( )_______________
List your child’s past medical treatment if any
____________________________________________________________________________
____________________________________________________________________________
___________________________________________________________________
Emergency Medical Authorization
The medical information provided on this form regarding my child is correct to the best of my knowledge. I herby give
permission for my child to receive over-the-counter medications marked on this application or prescription medications
provided by me in original labeled container as deemed necessary by the volunteer nursing staff. I understand that the
volunteer nursing staff who administers the medications according to the proper dosages shall not be held liable for any
adverse reactions to the medications administered. I give my permission for my child to engage in all learning and
recreational activities at the camp. I certify that my child is able to participate in those activities and that all medical conditions
or allergies of my child which may limit my child’s participation in activities are listed above. IN THE EVENT I CANNOT BE
REACHED IN CASE OF AN EMERGENCY, I HEREBY AUTHORIZE SWID’S DIRECTORS AND DESIGNATED
PERSONNEL TO GIVE MEDICAL ASSISTANCE TO MY CHILD. I ACCEPT FULL RESPONSIBILITY FOR PAYMENT OF
EXPENSES INCURRED AS A RESUTL OF ANY MEDICAL TREATMENT FOR MY CHILD.
Parent/Guardian Signature: ___________________________________________________ Date:________________
2013 Southwest Indiana District Children’s Camp Application
Camper’s Name: _________________________Church:________________________
Preferences
T-Shirt Size:
Child Small
Child Medium
Child Large
Adult Small
Adult Medium Adult Large
Adult X-Large Other
Nazarene Church registered with: _____________________________
The camp staff recognizes the importance of housing with a friend. We will attempt
placement with one
of your choices.
Roommate Choices: 1____________________ Church:______________________
2.____________________ Church:______________________
Southwest Indiana Children’s Camp Rules & Guidelines
All rules & guidelines are to be followed at all times for the best success of camp and
the camper’s experience of camp.
1. No cell phones will be permitted for campers. If any campers are found with them
they will be confiscated and returned to them upon departure of camp.
2. No one is allowed to leave camp grounds without permission of the directors.
3. All campers are expected to abide by the schedule for all activities.
4. Attire & Conduct should reflect modesty. Please watch your kids pack and make
sure they do not bring halter tops, short shorts or short skirts (must come to finger
tips), and low cut tops or pants. Girls - one piece bathing suits- NO BIKINIS.
Parents:
1.
Each child should be checked for head lice BEFORE coming to camp and
treated if needed 3 days prior to arrival. Someone will be available to check
heads before admittance to the dorms. If nits are found they will be sent home.
2.
Medications must be in original containers with clear instructions. (Example Pharmacy labeling for prescription drugs or original box with medication name
and dosing ranges for over the counter meds.) Loose medications without proper
labeling will not be accepted or distributed by the camp nurse.
I have read the above rules & guidelines and will commit to follow them.
Camper’s Signature_______________________________ Date_____________
Parent’s Signature________________________________
Date_____________
Camper Application
Children’s Ministries
Kids Camp 2014
(Completed grades 1 - 6 Spring 2014)
Shiloh Park
Marion, IN
June 23-27
Cost:
$205 if received before May 16
$225 if received after May 16
Camp Director:
Pastor Andy Wright
[email protected]