Summer Camp Registration Form

Transcription

1 OFFICE METRO FAX Summer Camp Registration Form Please submit a separate application for each camper or camp session. Please print or type. Session # Session start date: / / All fees are due prior to the beginning of the designated camp session. No fee will be refunded once the session has begun. Full name of camper Nickname: Birth date: / / Gender (circle one): M F Grade completed as of June: T-shirt size (circle one): Youth S M L or Adult S M L XL I would like to room with (name one): (Final rooming decisions are made by Camp Crucis.) Parent or Guardian name(s): Mailing address: Parent/Guardian Home church: Camp fees: See camp fee schedule for pricing information. Session Name: Session # (same as above) Camper Parish Name: Horsemanship fee $135 (optional in selected sessions) One time trail ride fee $40 $ Calculations: Session fee total: $ Donation to Camp Crucis Scholarship Fund: $ Subtotal: $ Fee $ Scholarship amount from $ Completed box above $ $ TOTAL AMOUNT DUE: $ Subtotal: Enter subtotal in next column $ Amount enclosed: $ A non-refundable $100 deposit is due with this registration form. / /

2 Camper s Health History Camper name: Name of Physician: Phone: If parent/guardian not available, in emergency notify: Phone: DTP series: series: Tuberculin test: List camper s allergies, allergic response and treatment requirement: Are there any specific limitations or conditions we should know about in order to better understand and help your child? Note: Camp Crucis is not equipped to accommodate special diets. List camper s operations or serious injuries and dates: Camper s chronic or recurring illnesses: Camper s behavioral disorders and prescribed medications: Additional medications being sent with camper: Unless the camp nurse is instructed otherwise during registration, each swimmer receives alcohol eardrops after each swim to aid in the prevention of swimmer s ear. Please notify the camp if this camper is exposed to any communicable disease during the three weeks prior to camp attendance. This health history and immunization report is true and accurate to the best of my knowledge. In the event of an illness or emergency, Hereby give permission for the staff of Camp Crucis to authorized medical treatment of my child by a licensed health care professional. I understand that there is a degree of risk and possible injury during any camp activity. I authorize the camp nurse to administer over- thecounter drugs to my child as needed. I have read the information regarding insurance and acknowledge the extent of coverage. Parent/Guardian signature: Date: 02/08

3 Camp Crucis Scholarship Fund Scholarship Application We realize for some families the cost of sending their children to Camp Crucis is a financial challenge or hardship. If you are in need of assistance, we want to help you. Our goal is that no child be turned away from summer camp because of a lack of funds. Our camper scholarships are offered for one session per summer as a shared ministry between Camp Crucis, the camper s family, and their church. Please complete this form and return it to the Camp office at 2875 Camp Crucis Court, Granbury TX Session # Today s Date / / Camper s full name Parent/Guardian name(s): Mailing address: City: State: Zip: Home phone: Work phone: address:

4 Camp Crucis Summer Camp Release Agreement Camper name: We at Camp Crucis want to inform you of our safety precautions at camp. Your camper will be required by our staff to wear safety equipment for some sports, horsemanship training, the ropes challenge course, and other activities requiring protective gear. Even with safety equipment and our competent staff present, it is important for you to note that any outdoor camping and recreational activity has inherent dangers that no amount of care, caution, instruction, or expertise can totally eliminate. It is important that this form be filled out, signed, and dated by the camper s parent or guardian and returned prior to the start of the camp session. Your camper will not be permitted to attend camp unless we have received this form. There is a degree of risk associated with camp activities, including swimming, horseback riding, the ropes course, field games, and other activities of the camp program. My child is authorized to participate in all such activities except as follows: In signing this document, I hereby certify that I give permission for the camper named above to participate in the camping program at Camp Crucis. I give permission for the camper to be transported in vehicles for camp-approved transportation and activities at Camp Crucis. I affirm that I have been advised of and understand the risks of camping and recreational activities at Camp Crucis and that such activ - ities involve certain risks. I understand that pictures and videos are taken at camp. I give permission for the use of such pictures and videos of my camper for the promotion of Camp Crucis. I also understand that photos of my camper may be posted on the Camp Crucis Web site for viewing by myself and others. I understand that the terms herein are contractual and not a mere recital. I have signed this document of my own free act and in consideration of the agreement by Camp Crucis to accept my child as a camper for the summer camp program. Except in the case of gross negligence, I hereby agree by execution of this document to release Camp Crucis, its director, staff, and board of directors, and all others acting for or on behalf of Camp Crucis from all liability whatsoever, for personal injury, or injuries to property, real or personal, caused by, or arising out of camping and other activities sponsored by Camp Crucis. Parent/Guardian name (print): Parent/Guardian signature: Date: / /

5 Community Guidelines for Camp Crucis To encourage and create a Christian community during this summer camp session, the following guidelines will be used for our life together. The success and enjoyment of this summer camp session and the experience in Christian fellowship will depend largely upon our mutual responsibility to God, to ourselves, and to one another. 1. As a youth ministry of the Episcopal Diocese of Fort Worth, the policies of the Diocese and the rules and polices of Camp Crucis will be followed. 2. Campers, sponsors, and staff have a responsibility to Camp Crucis. As good Christian stewards, we will show respect for the grounds, buildings, and property of the camp. Campers, sponsors, and staff will be held financially responsible for damages they incur. 3. All campers have a responsibility to the group by not leaving designated areas. Campers will participate in all group activities. 4. Campers and parents will take responsibility for dressing appropriately. Clothes that expose undergarments of any kind (bras, boxers, etc.) or clothes that expose the stomach or are backless (or near backless) are not appropriate attire for Camp Crucis. T-shirts or clothing with sayings or logos that could be deemed offensive (innuendoes, beer ads, cigarette ads, etc.) should be left at home. Swimwear should be appropriate for the Christian community. You may be asked to change clothes if it is decided by a staff member or counselor that your attire is inappropriate. 5. In the camp environment, body piercing can be hazardous. Earrings should be kept small. All other body piercings must be covered by clothing or band-aids. Tattoos must be covered by clothing or band-aids at all times. 6. Radios, recorders, tape and CD players, TVs, electronic and video games, skate boards, roller skates/blades, etc., should be left at home. Cellular phones, beepers, pagers, PDAs, or any other personal computers should be left at home or be turned in to the camp office for safekeeping. 7. There will be no possession or consumption of tobacco or alcoholic beverages. There shall be no use, sale, trade, barter, or possession of illegal drugs or artificial stimulants (Vivarin, NoDoze, etc.) at the camp. Abuse of any over-the-counter drugs is detrimental to a retreat atmosphere and will not be tolerated. There shall be no possession of weapons, knives, and/or guns. 8. Inappropriate language (profanity, etc.), innuendos, or gestures will not be used or tolerated. 9. No sexual activity or inappropriate displays of affection will be permitted. 10. Show consideration and respect for others through your actions and your words. Be thoughtful and considerate of others during quiet times and at lights out. 11. All campers are to remain on the camp property. Campers who drive their own cars to the camp must turn in keys to the staff at registration. 12. A written parental release is required to release a camper prior to the close of the session. All Lost & Found items will be kept until Aug. 15. Following that date, all remaining items will be donated to Mission Granbury. I have read the Community Guidelines, and I agree to abide by them while at Camp Crucis. If I break any of the guidelines, I know that my parent or guardian will be called, and I will be sent home. Camper signature: Date: / / I have read the Community Guidelines, and I agree to have my child abide by them while at Camp Crucis. I understand that if my child breaks any of the guidelines, I will be called an may be asked to come and pick up my child. Parent/Guardian signature: Date: / /