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Camp Quickinfo: When: July 12-16th Cost: $175

Camp Quickinfo: When: July 12-16th Cost: $175

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05/23/2012

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Camp Quickinfo:
 When: July 12-16thCost: $175 Camper (Deposit of $80 due with application)Application: DUE SUNDAY MAY 8th!!!!
Remember:
The camp fills up EXTREMELY quickly. This is one of the premiere church camps inthe nation. Turn your forms in ASAP to ensure you have a spot.Last year we had people turn in their forms after the deadline, in hopes of usbeing able to come to the camp. Unfortunately, due to popularity of the campthey were unable to attend. PLEASE turn your form in on time.We will also have an all parent/youth meeting before we leave on Thursday July8
th
7-
8pm. We’ll have last minute instructions for everyone, and answ
er anyquestions anyone might have. If you have any questions feel free to email or callme.Cell- (940) 230-0512Email-Robert.jordan@thechurchofcorinth.org
 
OUTH
C
 AMP 
 A
PPLICATION
 
This form is to be completed by applicant’s Parent/Legal Guardian and signed by both the Parent/Legal
Guardian and the Camper.
All information must be complete. Incomplete applications will incur a $3 charge upon receipt of the
 
application.
Missing information must be received before application will be accepted.
 
DVD Qty (optional $15/ea
 – 
Lakeview Camps only)
 
C
AMPER
I
NFORMATION
 
Name Phone Camp Week Attending Week 2Address City State ZipMale Female Date of Birth / / Grade next fall T-shirt Size
(adult)
S / M / L / XLEmail address robert.jordan@thechurchofcorinth.org Church TheChurchOfCorinth Church City Corinth, TXIs there anyone your child should
NOT
be released to? Yes No If yes, Name(s)
H
EALTH
H
ISTORY
 
The camp insurance carrier does not cover pre-existing medical conditions.
 
IMMUNIZATIONS: List the last date given (the State of Texas requires the dates to be listed).Oral Polio DPT (Diptheria/Pertussis/Tetanus) MMR (Measles/Mumps/Rubella)[ We have chosen not to immunize. Parent Signature Date
 
]CHRONIC/RECURRING CONDITIONS: Check all that apply.
Asthma/Respiratory ProblemsBleeding/Clotting DisorderConstipationDiabetesEar InfectionEmotional DisturbancesEpilepsyFaintingHeadachesHearing ImpairmentHeart DiseaseHypertensionKidney Disease/Bed WettingMusculoskeletal DisorderNosebleedSeizuresSickle Cell Trait or DiseaseSpecial Dietary RegimenOther
Date of last examination Are activities restricted? Yes NoIf yes, please explainALLERGIES:
AnimalsFoodInsect BitesMedicines/DrugsPlantsPollenHay FeverOther
Can your camper swim? Yes No A littleMay your camper swim at camp? Yes NoCheck if your child wears Contact Lenses Glasses Dental AppliancesMay be given Tylenol? Yes No May be given Benadryl? Yes No May be given Ibuprofen? Yes NoMy Camper may be given over the counter, non-prescription medications or applications, not to exceed the recommended dosage for stomachdiscomfort, burns, cuts, insect bites, rash or scrapes. Yes No
List Exceptions
Physician Name PhoneHealth Insurance Carrier Policy/Group #
P
ARENT
/G
UARDIAN
I
NFORMATION
 
Name Day Phone Evening PhoneIf Parent/Guardian cannot be contacted, please notify:1) Name Day Phone Evening Phone2) Name Day Phone Evening Phone
A
PPLICATION
A
UTHORIZATION
 
I authorize the adult in charge to consent to medical treatment when either my assignee or I cannot be contacted. I understand that every effort will be made tocontact me regarding medical attention given to my child. I also understand that participants at Lakeview Camp are liable for damage caused intentionally ormaliciously. Damage caused by a participant will be billed directly to the participant responsible and their legal guardian. I understand that youth camp is a voluntaryactivity. Student must be willing to cooperate with the overall spirit and schedule of the camp. Finally, I understand that every effort will be made to room churchgroups in the same cabins. However, due to the structure of the camp and the limited number of beds, this is not always possible. I also grant my permission toNorth Texas District Council to use photographs (individual or group) and/or multimedia images and recording in the best interest of the North Texas DistrictCouncil. I have reviewed the camp information sheet and gone over the camp and dress code policies with my child. Camper signature required: Agree to abide bycamp and dress code policies.
Parent Signature Date
(signature required if camper under age 18)
Camper Signature Date
(signature required)
 
 
1:2
Important
 
Camp
 
Information
 
for
 
Parents
 
Please
 
read
 
the
 
following 
 
information
 
and
 
review 
 
the
 
Camp
 
Policies
 
&
 
 What 
 
to
 
 Wear
 
 with
 
your
 
child.
 
Registration
 
&
 
Check
 
Out 
 
Registration
 
on
 
the
 
first
 
day
 
of 
 
camp
 
is
 
from
 
2:00p-3:30p. When
 
 you
 
arrive
 
at
 
camp,
 
the
 
Youth
 
Pastors
 
will
 
register
 
in
 
the
 
 Activity Center
 
while
 
the
 
 youth
 
enjoy
 
pre-camp
 
kick-off activities
 
in
 
the
 
Multi-Purpose
 
building.
 
The
 
Camp
 
gates
 
will
 
open
 
no
 
earlier
 
than
 
2:00p
.
You
 
may
 
pay
 
 your
 
campers’
 
balance
 
by
 
check 
 
or
 
credit
 
card.
 
Please
 
make
 
all
 
checks
 
payable
 
to
 
NTDC.
 
To
 
expedite registration,
 
church
 
groups
 
should
 
pay
 
 with
 
one
 
check.
 
On
 
the
 
last
 
day
 
of 
 
camp,
 
we
 
will
 
dismiss
 
around
 
11:00a. Cabins
 
must
 
be
 
cleaned
 
out
 
and
 
all
 
items
 
removed.
 
 We
 
are
 
not
 
responsible
 
for
 
lost
 
items
 
or
 
items
 
left
 
at
 
camp.
 
Meals
 
Meal
 
times
 
will
 
be
 
at
 
9:00a,
 
12:30p,
 
and
 
6:00p.
 
The
 
snack 
 
bar
 
will
 
be
 
open
 
3
 
times
 
a
 
day
 
in
 
case
 
campers would
 
like
 
some
 
candy
 
or
 
sodas,
 
so
 
 you
 
may
 
want
 
to
 
send
 
$3-5
 
per
 
day
 
for
 
concessions.
 
No
 
lunch
 
will
 
be
 
served
 
on Monday
 
or
 
Friday.
 
Medication/Special
 
Medical
 
Requests
 
Please
 
be
 
sure
 
to
 
complete
 
and
 
sign
 
the
 
Youth
 
Camp
 
Medication
 
Form
 
if 
 
 your child
 
needs
 
to
 
take
 
any
 
kind
 
of 
 
prescription
 
medication
 
while
 
at
 
camp,
 
or
 
if 
 
there
 
are
 
any
 
special
 
needs
 
that
 
our
 
nurseshould
 
be
 
made
 
aware
 
of.
Asthma
Inhalers
 
are
 
the
 
only
 
form
 
of 
 
medication
 
that
 
the
 
camper
 
will
 
be
 
allowed
 
to
 
keep
 
with
 
them. Please
 
send
 
two
 
in
 
case
 
one
 
is
 
lost. All medication must be in the original container.
 
Mail
 
If 
 
 you
 
are
 
interested
 
in
 
sending 
 
 your
 
camper
 
mail
 
while
 
at
 
camp,
 
please
 
forward
 
it
 
to
 
the
 
student
 
c/o
 
Lakeview
 
Camp,
 
5128
 
FM
 
66,
 
 Waxahachie,
 
TX,
 
75167.
 
 Not available for El Har Camps.
 
 We
 
do
 
not
 
forward
 
mail
 
that
 
is
 
sent
 
to
 
the
 
District
 
Office.
 
Security
 
&
 
Phone
 
Policy
 
 We
 
are
 
fully
 
aware
 
of 
 
our
 
great
 
responsibility
 
in
 
the
 
care
 
of 
 
 your
 
child.
 
In
 
the
 
case
 
of 
 
anemergency,
 
 you
 
will
 
be
 
notified
 
immediately.
 
Incoming 
 
calls
 
are
 
not
 
allowed,
 
except
 
in
 
cases
 
of 
 
emergency,
 
out
 
of consideration
 
for
 
other
 
campers
 
and
 
planned
 
activities.
 
Camp Staff 
 
maintain
 
24-hour
 
security
 
staff 
 
and
 
restricts access
 
to
 
workers
 
and
 
campers.
 
Camp
 
Policies
 
By
 
registering 
 
for
 
camp,
 
 you
 
agree
 
to
 
abide
 
by
 
all
 
rules
 
set
 
forth
 
by
 
the
 
North
 
Texas
 
District
 
Council
 
of 
 
the
 
 Assemblies
 
of 
 
God,
 
Lakeview
 
Camp,
Camp El Har,
and
 
the
 
District
 
Youth
 
Director.
 
 
Serious
 
offenses
 
such
 
as
 
possession
 
of 
 
banned
 
substances
 
(drugs,
 
alcohol,
 
tobacco,
 
firearms,
 
etc.)
 
shall
 
be
 
met with
 
immediate
 
dismissal
 
from
 
camp
 
and
 
will
 
be
 
reported
 
to
 
local
 
authorities.
 
 
 Anyone
 
who
 
leaves
 
the
 
camp
 
without
 
approval
 
of 
 
the
 
Camp
 
Director
 
will
 
be
 
dismissed
 
from
 
the
 
camp
 
upon his or her
 
return.
 
In
 
addition,
 
local
 
authorities
 
will
 
be
 
notified.
 
 
 We
 
restrict
 
the
 
use
 
of 
 
 vehicles
 
operated
 
by
 
campers
 
who
 
provide
 
their
 
own
 
transportation.
 
No
 
camper
 
will
 
beallowed
 
to
 
leave
 
the
 
property
 
after
 
check-in,
 
unless
 
a
 
parent
 
has
 
contacted
 
our
 
office
 
and
 
made
 
prior arrangements.
 
 
No
 
hazing 
 
of 
 
other
 
students
 
will
 
be
 
tolerated.
 
 
No
 
pagers,
 
cell
 
phones,
 
CD
 
players,
 
walkmans,
 
etc.
 
will
 
be
 
allowed
 
at
 
camp.
 
 
In
 
addition,
 
students
 
and
 
their
 
parents/guardians
 
will
 
be
 
held
 
fully
 
responsible
 
for
 
any
 
damage
 
caused
 
to
 
Lakeview
 
Camp’s
or Camp El Har’s
property.
 
 
The
 
Discipline
 
Policy
 
includes:
 
warnings,
 
timeouts,
 
KP
 
duty,
 
work 
 
details,
 
etc.
 
Refusal
 
of 
 
discipline
 
will result
 
in
 
dismissal
 
from
 
camp.
 
 
Refunds
 
will
 
not
 
be
 
issued
 
for
 
camp
 
dismissals.
 
 
Lice
 
Policy:
 
Lice
 
is
 
 virtually
 
impossible
 
to
 
treat
 
in
 
a
 
cabin
 
community
 
such
 
as
 
camp.
 
Therefore,
 
if 
 
a
 
student
 
is
 
found
 
to
 
have
 
lice,
 
we
 
will
 
have
 
to
 
ask 
 
that
 
they
 
be
 
picked
 
up
 
from
 
camp,
 
treated,
 
and
 
be
 
nit
 
free
 
for
 
48
 
hours before
 
returning 
 
to
 
camp.
 
No
 
refunds
 
will
 
be
 
issued.
 
Please
 
check 
 
 your
 
student
 
before
 
coming 
 
to
 
camp.
 
 
NO
 
Visitors
 
are
 
allowed
 
on
 
the
 
campgrounds.
 
Lodge
 
Policy (Lakeview Camp only)
 
Because
 
we
 
want
 
as
 
many
 
students
 
as
 
possible
 
to
 
be
 
able
 
to
 
attend
 
camp,
 
we
 
are
 
offering 
 
additional
 
lodging 
 
in
 
the
 
McDonnell
 
Lodge
 
in
 
the
 
case
 
that 
 
the
 
cabins
 
are
 
filled
 
to
 
capacity
.
 
 Who
 
stays
 
in
 
the
 
Lodge
 
will
 
be determined
 
by
 
the
 
following 
 
factors:
 
Female
 
camper,
 
District
 
Youth
 
Director
 
approval,
 
and
 
Youth
 
Leaderapproval.
 
Female
 
 Adult
 
 Workers will
 
be
 
in
 
the
 
Lodge as well.
 
Camp
 
Security
 
will
 
also
 
monitor
 
the
 
surrounding 
 
area. Thecamp does not provide towels or bedding.
 

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