AL Youth Camp 2013 |Registration Form

Ages 13-20, single. $85 per student (includes Social ticket).T-shirts, merchandise and concessions are available for an additional cost. Make checks payable to AL Youth UPCI. On-site registration begins Tuesday morning at 9am. Friday evening service begins at 6pm.
NOTE-Paintball participants under 18 years must have a signed release form. Paintball release form follows. ($6 for 2 games.)
Credit/debit cards accepted


Student’s Name___________________________Date________________Age___________ Sex______Race____________Nationality________________________________ Address___________________________________________________________ Cell phone_______________________ E-Mail:____________________________
Parent/Guardian ____________________________________________________ Home Phone_______________________ Cell Phone_________________________ Work Phone_______________________ E-mail: ____________________________ Emergency contact and phone# __________________________________________ List the full names of at least two authorized individuals (besides yourself) that may check your child out of camp for personal/emergency reasons: ______________________________________________________________________________ Home Church ______________________________________________________ Pastor’s Name_____________________________Pastor’s Phone _________________________ Youth Leader’s Name _____________________________ MEDICAL INFO Are you under doctor’s care? ( ) Yes ( ) No If so, for what treatment? _____________________________________________ Allergies: __________________________________________________________ Do you have any known medical problems? ( ) Yes ( ) No If so, list treatment and medication being taken___________________________ _________________________________________________________________ Have you had a tetanus shot in the past twelve months? ( ) Yes ( ) No Are you a diabetic? ( ) Yes ( ) No Glasses ? ( ) Yes ( ) No Contact Lenses? ( ) Yes ( ) No Hearing Aid ? ( ) Yes ( ) No Other:________________________________ Do you have medical insurance? ( ) Yes ( ) No Will it take care of emergencies? ( ) Yes ( ) No Insurance Carrier:________________________ Policy Number:________________________

In the event of sickness or accident, I hereby give permission to the camp director/chaperones to secure emergency medical care. I hereby assume all risk and liability of my child participating in this activity:

Parent/Guardian Signature (Required if under 18)

I have read the guidelines and agree to abide by all of them. I will cheerfully submit to and cooperate with all camp staff. I understand that my failure to do so will result in my immediate dismissal from camp with no refund provided: (Please read guidelines before signing)

Student Signature

As Pastor, my signature signifies that I (or my Youth Leader) have reviewed the camp rules with this student and they will obey the guidelines. I recommend this camper to be accepted.

Pastor’s Signature

Youth Camp guidelines, schedule and paintball release form follows.
CAMP OFFICE USE ONLY: Amount Paid $__________ Check# _________Processed by: __________

Group #1 (ages 13-15) Group #2 (ages 16-20). NOTE-Group#1 will have first access to the showers each day due to an earlier dinner time.

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Service with IBC Praise and Bro Staten- 8pm

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Registration-9-11am Staff meeting-10am Gravity Kickoff service-11-12:30pm (Ray Salas) Orientation- 12:30-1pm Lunch-1-2pm Recreation- 2-5pm Choir showers open-3:15pm Choir practice-4:30pm Regular showers open- 4:30 Dinner: Group #1-5:45-6:30pm (ages 13-15) Group #2-6:30-7:15pm (ages 16-20) Service with Bro Staten- 8pm

>I.B.C. T-shirt day/ Staff vs. Campers paintball tournament/Geek Swag night
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>Day service with Bro Bankens / I.B.C Praise in evening service
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Girl’s breakfast-9-9:50amGuy’s breakfast 10-10:50am Girls Session-10-10:50am- Michelle Penton Break-out Session- 11-11:50am Group #1-Ages 13-15-Brandon Nero Group #2- Ages 16-20-Adam Maddox Day Service 12-1pm- Rodney Bankens-“The Culture of Darkness” Lunch 1-2pm Recreation 2-5pm Choir showers open-3:15pm Choir practice-4:30pm Regular showers open-4:30 Dinner: Group #1-5:45-6:30pm (ages 13-15) Group #2-6:30-7:15pm (ages 16-20)

9-9:50am-Guy’s Breakfast 10-10:50am –Girl’s Breakfast Guy’s Session-10-10:50am- Jeremy Sherrill Break-out Session- 11-11:50am Group #1-Ages 13-15-Nathan Salinas Group #2-Ages 16-20 –Brian Harris Day Service- 12-1pm-Michael Thomas Lunch- 1-2pm Recreation- 2:30-5pm Choir showers open-3:15pm Choir practice-4:30pm Regular showers open-4:30 Dinner: Group #1-5:45-6:30pm (ages 13-15) Group #2-6:30-7:15pm (ages 16-20) Service with Bro Staten- 8pm

(Geek Swag party to follow immediately after service. Followed by the Staff vs. Camper paintball tournament.)

>No classes/ Staff vs. Campers softball game
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Breakfast for everyone- 10-12pm Day service- 12-1pm- Shawn Meeks (No classes) Recreation- 1-3pm (Staff vs. campers softball game) Showers open- 2:15pm Dinner- 3:00-5:00pm Service with Bro Staten- 6pm

The following guidelines will help ensure the safety of students and preserve a Christian atmosphere.
1. Students under 18 years of age must have their registration form signed by their parent and/or guardian. All campers must have their form signed by their pastor. 2. All campers must register and reside on campus in the camp dorms. 3. No camper is permitted to check out and/or leave the campgrounds before Friday evening’s service without first securing written permission from their parent/guardian and undergoing the release process. 4. All campers are expected to promptly attend and participate in all scheduled activities. A student may be excused from the group only if it involves health or personal issues. This must be with the camp principal’s approval. 5. Only registered campers are allowed to participate in the youth camp activities. No unregistered students or adults are allowed on campus. 6. Unknown/unregistered persons are not allowed in the dorm areas (except on Tuesday morning and Friday evening for arrival and departure times) 7. Unregistered guests are only permitted to attend the evening services. Unregistered guests are required to be off the campus within 20 minutes of the service conclusion. 8. Camp officials reserve the right to ask any individual who refuses to cooperate with any aspect of camp policy to immediately leave the campgrounds. 9. Students are required to vacate the premises after Friday evening’s service. 10. Students that have driven themselves to camp must surrender their keys to the staff upon arrival. Students are not allowed to keep the keys to their vehicle if it is present on campus. 11. Appearance guidelines for registered campers: Modesty must be observed in clothing at all times. Appearances should be Godly. a. For Females:  All shirts must have sleeves.  The hair should be kept neatly.  Hair should be trimmed nicely, and not  Makeup is not allowed. covering the ears or collar.  All dresses and skirts must cover the knees.  Guys must be clean shaven. Mustaches or  Pants, culottes, and shorts are not allowed. beards are not allowed  All apparel must have sleeves. c. Jewelry is not allowed.  Necklines should be modest. d. Sleepwear is only to be worn inside the dorms.  Transparent or semi-transparent clothing is e. General hygiene practice and daily showers are not allowed. encouraged. b. For Guys: f. Clothing logos or insignias that support anti Pants must be full length. Shorts are not Christian values are not allowed allowed. 12. No fighting (physically or verbally). No rough play or wrestling between students 13. No inappropriate physical contact between students. Hugging, kissing, holding hands and other acts of physical contact are prohibited. No unmarried couples shall be together without supervision while on campus.. 14. The “6 inch space rule” applies to all students in every situation. This includes while standing, sitting or walking. 15. Students are expected to keep their hands to themselves at all times. Students must remain in visible, open areas at all times. 16. Profanity and/ or obscene gestures or referrals will not be tolerated (whether from media devices or a student). All behavior should be as Christ like as possible. 17. No dangerous articles such as guns, knives, lighters, fireworks or other potentially hazardous items are permitted. a. Shrink-wrap, water guns and similar disruptive items are forbidden. Possession of these articles may result in immediate expulsion from camp. b. It is solely the staff’s discretion to determine whether an item is considered dangerous or potentially dangerous. 18. No alcohol or tobacco in any form. 19. Only prescription drugs are allowed on campus. All medication must be registered with and submitted to the camp nurse. All medication must be administered under his/her supervision. 20. No unauthorized handling of sound equipment or musical instruments 21. No solicitation will be allowed other than that by the District Departments and guest ministries. The Camp Administrator must approve all solicitation. 22. Any individual expelled from any camp shall not be permitted to attend any other camp in the same calendar year without the approval of the Camp Administrator of the camp from which he was expelled, the District Superintendent, and upon recommendation by his pastor 23. Camp Administrators reserve the right to check all registered campers for head lice

Alabama Youth | Paintball Release Form
Alabama District UPCI Inc. 1950 Flinn Rd. Pike Road, AL 36064
IF PARTICIPANT IS UNDER 18, THIS FORM MUST BE SIGNED BY LEGAL PARENT/GUARDIAN Recreational Activity Release of Liability, Waiver of Claims, Express Assumption of Risk and Indemnity Agreement

Express Assumption of Risk Associated with Recreational Activities.
I hereby affirm and acknowledge that I have been fully informed of the inherent hazards and risks associated with the recreational activity generally described as paintball including the rental of equipment and transportation associated therewith of which I am about to engage in. Inherent hazards and risks include but are not limited to: 1. Risk of injury from the activity and equipment utilized is significant including the potential for permanent disability and death 2. Possible equipment failure and/or malfunction of my own or other's equipment. 3. This activity takes place outdoors and therefore includes risks associated with exposure to elements, excessive heat, hypothermia, impact of the body, injection of water into my body orifices, encountering objects either natural or man-made, exposure to animal with the attendant risks of kicking, biting, shying away, running off or otherwise moving in an unanticipated manner causing injury and/or death. 4. My own negligence and/or the negligence of others, including but not limited to operator error and guide decision making including misjudging terrain, rapids, weather, trails, and route location. 5. Attack by or encounter with insects, reptiles, and/or animal. 6. Accidents or illness occurring in remote place where there are no available medical facilities. 7. Fatigue, Chill, and/or dizziness, which may diminish my/our reaction time and increase the risk of accident. *I understand the description of these risks is not complete and that unknown or unanticipated risks may result in injury, illness, or death. Release of Liability, Waiver of Claims and Indemnity Agreement In consideration for being permitted to participate in the activity describe above, I hereby agree, acknowledge and appreciate that: 1. I HEREBY RELEASE AND HOLD HARMLESS WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER CAUSED BY NEGLIGENCE OR OTHERWISE, the following named persons or entities, herein referred to as releasees. 2. To release AL District UPCI Inc. their officers, directors, employees, representatives, agents, volunteers, and vessels from liability and responsibility whatsoever and for any claims or causes of action that I, my estate, heirs, survivors, executors, or assigns may have for personal injury, property damage, or wrongful death arising from the above activities whether caused by active or passive negligence of the releasees or otherwise. By executing this document, I agree to hold the releasees harmless and indemnify there in conjunction with any injury, disability, death, or loss or damage to person or property that may occur as a result of engaging in the above activities. 3. By entering into this Agreement, I am not relying on any oral or written representation or statements made by the releasees, other that what is set forth in this Agreement
This release shall be binding to the fullest extent permitted by law. If any provision of this release is found to be unenforceable, the remaining terms shall be enforced.


______________________________________________________________________________________________________________ (Address) ____________________________________________________________ (City) _________________________________________ (Phone Number) _________________________________________ (Date of Birth) __________________________________ (State) (Zip Code)

__________________________________________________________ (E-mail) __________________________________________________________ (Today’s Date)

For Participants of Minority Age, this is to clarify that I, as Parent, Guardian, Temporary Guardian with legal responsibility for this participant, do consentand agree not only to his/her release of all releasees, but also to release and indemnify the releasees from any and all liabilities incident to his/her involvement in these programs for myself, my heir, assigns, and next of kin.

x_________________________________________ Signature of Parent or Legal Guardian if participant is a minor/under18. (By their signature, they on my behalf release all claims that both they and I have)

x__________________________________________________________ (Name of Parent or Adult Guardian PRINT ONLY) x__________________________________________________________ (Name of minor PRINT ONLY)

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