2008 YOUTH CAMP REGISTRATION

CAMP CHOICE  :  _____ CAMP NOAH (July 7th – 11th, 2008)

                            _____ CAMP RIVER WILD (June 29th – July 4th, 2008)

                            _____ CAMP KUM-BA-YAH (July 13th – 19th, 2008)

                                   

 1.  Overnight option for Camp Noah only ($5 extra):                _____ Yes            _____ No

 2.  Indicate bus stop for Camp Noah:      _____St. John's     _____ Sunnyway     _____Milky Way

 3.  Child care before 8:00 AM for Camp Noah:  _____ YES, I will need childcare _____NO, I do not need childcare

 4.  Child care needed for Camp Noah:  _____Monday           _____Tuesday     _____Wednesday             _____Friday

 

CAMP T-SHIRT (included with camp fee) check one:

·          YOUTH SIZES:     _____ Small (6-8)       _____ Medium (10-12)      _____ Large (14-16)

·          ADULT SIZES:      _____ Small         _____ Medium      _____ Large     _____ X-Large        _____ XX-Large

 

Camper's Name _______________________________________________________ Male ____    Female ____

 

Address ___________________________________________________________________________________

                        (street)                                       (city)                                                    (state)          (zip)

Date of Birth _____________Grade completed June 2008 __________ E-mail __________________________

 

Parents' Names _____________________________________  Phone ________________________  

Family Doctor _______________________________________  Phone ________________________

 

Camper's Church affiliation (if any)_________________________________________________________

 

Person to contact in case of emergency (other than parent)

Name _______________________________________________________________________________

Phone ____________________________ Relation to camper ___________________________________

 

Medical Insurance Policy Holder's Name ____________________________________________________

 

Medical Insurance Co. ______________________________  Policy # ____________________________

 

Indicate request for cabin mates here:___________________________________________________

 

Attach a separate sheet indicating any allergies, physical limitations or medical conditions. Also, explain fully if the

camper will have in their possession any prescribed or over-the-counter medication. (What is the medication;

what is the camper's condition; how often should the medication be administered and does it need refrigeration?)

 

I authorize the Camp Director of St. John's Camp to obtain emergency medical treatment for my child should it be necessary.

 

·          CAMPERS WILL NOT BE ADMITTED UNLESS THE REQUIRED SIGNATURES APPEAR BELOW

 

                ___________________________    __________________________________________________

             (today's date)                                                                               (signature of parent/guardian)         

"Code of Conduct"

 

The following are NOT permitted on St. John's Camp property or on a Camp-sponsored field trip:

·         Possession or consumption of alcohol

·         Possession or use of illegal drugs

·         Possession or use of tobacco products

·         Matches, lighters, fireworks, or smoke bombs

·         Inappropriate language

·         Willful destruction of property

·         Boys in girls' cabins, girls in boys' cabins

·         Violation of established curfews

·         Any item or action that intimidates or harasses individuals or groups

·         Other conduct as determined inappropriate by the Camp Director

 

Steps to be followed if a violation occurs:

                1.  The Camp Director will discuss the concern with the camper/counselor.

2.  The Camp Director may request that a telephone call be made to the youth's parent/guardian to

make them aware of the situation; the Camp Director and the youth will be present at the time of the call.

3.     The Camp Director may request the parents to arrange transportation home for the camper/counselor.

 

·         We have read and discussed the St. John's Camp "Code of Conduct.”

·         We agree that the camper will exhibit conduct in accordance with the code.

 

______________________________                     _______________________________

     (camper's signature and date)                                     (parent / guardian's signature and date)

 

A $10 non-refundable registration fee is included as part of the camper fee. 

ALL questions on this form MUST be answered for registration to be accepted.

The camp fee balance is due two weeks prior to the start of the event.

 

            Mail to:             St. John's United Church of Christ, Church Office

                                    1811 Lincoln Way East, Chambersburg PA 17202