25072 State Hwy 18, Springboro, PA 16435

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1 Dear Parents, The Committee is already busy at work planning for the 2008 camp season. Please read this page before proceeding with application that follows on page 3. On the reverse of this sheet is information you should keep regarding Camp. ***This year s camp season will begin with the first week on Sunday, July 13 th and run for 3 consecutive weeks: Week 1 Sunday, July 13 Saturday, July 19, Ages 7-17 $200 Week 2 Sunday, July 20 Saturday, July 26 Ages 7-17 $200 Week 3 Sunday, July 27 Sunday, August 3, Ages 9-17 $225 (Tammie Week) Please note that registration begins at 3:00 PM and pick-up for children is Saturday morning at 10:00 AM for Weeks 1 and 2. Please plan accordingly. Our camp program is funded by camp fees, supplemented by only a few donations. While benefits from the wonderful accommodations that provides, the day-to-day cost of operating the camp program comes from the weekly fees. We do not wish for camp to be out-of-reach for any child and family. We encourage anyone who faces a hardship to please notify us through your parish priest or by contacting us directly. We have and will continue to offer assistance to those families in need. ***All children attending camp must submit prior to their arrival completed health forms. Your child cannot be admitted without a physical signed by a medical professional. We will no longer accept physicals that are filled out by parents alone. Please do not disappoint your child by failing to provide the necessary medical information. ***Сва деца која желе да буду у кампу морају пре свога доласка попунити здравстевне податке. Деца без здравстених података попуњених и подписаних од медецинског особља неће бити примљена у камп. Камп од сада више неће примати медецинске податке које су попунили и потписали сами родитељи. Не дозволите да ваше дете буде одбијено зато што нема здравстевене податке потврђене од медецинског особља. ***If all or part of your camp fee is being paid by your Church, an auxillary organization, or a third-party, that amount must be paid when your child arrives at Camp. Regretfully, we cannot afford to wait for payment. ***Уколико црква или нека црквена организација плаћа део или целу суму за Камп детета, молимо вас да уплату извршите када доведте ваше дете у Камп. Молимо вас обратите пажњу на овај детаљ. We look forward to having your child/ren at Camp this year!! Please fill out the application completely and send it in without delay. Thank you, Fr. Zivojin Jakovljevic, Camp Director ST. SAVA CAMP COMMITTEE.

2 INFORMATION FOR CAMPERS AND PARENTS Address during camp: St. Sava Camp State Hywy #18 Springboro, PA Telephone during camp: (814) Check-in time: Check-out time: Visiting the camp: Sunday at 3:00 PM Saturday at 10:00 AM (except Tammie Week). Please be considerate of the Camp Staff and show up on time! The Camp Staff needs time to prepare for the following week. Everyone is encouraged to visit camp and observe your child s activities. All visitors must sign in at the office and be issued a visitor s badge. Clothes & Miscellaneous to pack: Bedding: sleeping bag, two sheets, 2-3 blankets, pillow, and pillowcase Towels: 3 Towels, 3 washcloths, 1 beach towel Tolietries: comb, toothbrush, toothpaste, soap, shampoo, sun screen, deodorant Clothing: sturdy jeans, sweatshirts, daily change of underwear, socks, other clothes (shorts, t-shirts, etc.) pajamas, and swimming suit (no two piece-- including tankini bathing suits for girls or bikini trunks for boys). For boys: one pair of pants and suitable shirt for church services (jeans t-shirts, and tennis shoes are not acceptable!) For girls: skirt and blouse, or dress (dresses and blouses should have sleeves; skirts and dresses should be knee length. Nothing short) For Waldameer, please bring a swimming bag to pack a towel, swim sandals change of clothing for after the swim park and a wallet or change purse for spending money at the amusement park. Costumes: We are not responsible for locating and/or providing costumes during Tammie Week. Misc: fishing gear **Please do not send valuables --jewelry, etc.-- with your child. We will not be responsible for their security. Extra spending money: The limit is $25 per child. Items not permitted at camp: Cars driven by campers, weapons, cell phones, ipods, radios, walkman, tape players, walkie-talkies. No snacks are permitted in the barracks. Campers will be permitted to eat snacks only during free time in the afternoon and evening. Camp fee: $100 deposit with the application + $100 balance = $ total for Week 1 or 2 $100 deposit with application + $125 balance = $ total for Week 3 Parents please note: Please fill out all sections of the Camper Registration Form. The consent and responsibility waiver must be signed in order for us to operate the camp program. Camp strictly prohibits alcoholic beverages, illegal drugs, tobacco (smoking, chewing, etc.), fireworks, or weapons of any kind. Any violation will result in immediate dismissal from camp. Make checks payable to ; mail it to: Dee Dee Baskot, 1704 Vermont Ave, West Mifflin, PA For more information, please call Dee Dee Baskot at or Vesna Meinert at or vgtm@earthlink.net. Please note that applications received after June 25th will be assessed a late processing fee of $25 per application. No or phone reservations.

3 Contact:, c/o Dee Dee Baskot, 1704 Vermont Ave, West Mifflin, PA CAMPER INFORMATION Please Print Clearly Camper s Name: Last First Middle Initial Address: Number/Street City address for confimation: State Male Female Camper s of Birth (M/D/Y): Parents Names: How many years has your child attended camp? Please include this year. Home Phone: Work Phone: Cell Phones: (Mom) Emergency contact: (Other than parent) Relationship to camper: (Dad) Phone: Parish Name and location: Is camper baptized Orthodox: Krsna Slava: If your child has/had special medical or physical needs or is under a physican s care for an ongoing physical or behavioral condition or if your child has an individual education plan at school, please check this box and explain on a separate sheet of paper Camp Season For Office Use Only PLEASE INDICATE WEEK(S) DESIRED DEPOSIT OF $100 IS REQUIRED 3 PM REGISTRATION WEEK 1, FEE: $ Sun., July 13 - Sat., July 19, 2008, Ages 7-17 WEEK 2, FEE: $ Sun., July 20 - Sat., July 26, 2008, Ages 7-17 WEEK 3, FEE: $ Sun., July 27- Sun., Aug. 3, 2008, Tambura Week, Ages 9-17 Only plan to attend Week 3 if you dance and/or play. Please note that applications received after June 25th will be assessed a late processing fee of $25 per application. : Deposit: Ck# Paid: : Balance: Ck# Paid: Payment by Church/organization: : Ck# Paid: Camper Cash: Ck/Ca Paid: Photo: Ck/Ca Paid: Allergies: Y/N Medications: Y/N Check in at 3PM; Check out time for Weeks 1 and 2 Saturday morning at 10 AM.

4 Swimmer: No Yes: Beginner Intermediate Advanced Only those campers who also have their parent s express written consent will be allowed to use the lake and pool. For those who do not know how to swim, there is a shallow water section. A certified lifeguard supervises all aquatic sessions. Child s Special Interests: Health Forms The health forms provided with this application do not need to be submitted with your deposit/registration, however, it must be completed in full and be presented at camp registration Remember: No form, No camp!!! When you have filled all the information on this application, please read the paragraphs below and sign the consent and/or responsibility waiver. These are necessary not only for your child to attend Camp this season, but also for us to operate the camp program. PARENT/GUARDIAN AUTHORIZATIONS, PERMISSIONS AND AGREEMENT This health history is correct and complete as far as I know. The person herein described has permission to engage in all camp activities except as noted. I hereby give permission to the camp to provide routine health care, administer over-the-counter medications, administer prescribed medications, and seek emergency medical treatment including ordering x-rays or routine tests. I agree to the release of any records necessary for treatment, referral, billing, or insurance purposes. I give permission to the camp to arrange necessary related transportation for me/my child. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the camp to secure and administer treatment, including hospitalization, for the person named above. I understand that my insurance coverage for my child will be used as primary coverage in the event medical intervention is needed. I further understand that I will be responsible for expenses not covered by my insurance. I understand all reasonable safety precautions will be taken at all times by / and its agents during camp. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree not to hold the Serbian Orthodox Diocese of Eastern America, their clergy, the /, its leaders, employees, and/or volunteers liable for damages, losses, disease, or injuries incurred by the subject of this form. I hereby give my permission to take field trips while attending camp at St. Sava s Camp, (Springboro) PA. I agree that my child will abide by all the rules and guidelines set forth by / for the safety and good health of the campers at camp. I also agree that if my child has to return home due to discipline violations, it will be at my own expense. I agree to indemnify and hold harmless, the Serbian Orthodox Diocese of Eastern America, their clergy, the /, their leaders, employees, and/or volunteers from any expenses, loses, claims, or damages incurred as a result of the acts or omissions of the subject of this form. This completed form may be photocopied for trips out of camp. I hereby agree to indemnify and hold harmless the Serbian Orthodox Diocese of Eastern America, the /, their clergy, officers, directors, employees, staff and volunteers from any and all expenses, claims, costs or attorney fees incurred as a result of claims, actions and/or suits brought by me, my child or on my behalf or on my child s behalf or by anyone else as a result of any accident of injury occurring to me or my child. I give permission for my child to participate in all camp activities, except the following (please list reason for each activity denied): Activity and Reason for Denial of Permission Signature of parent or guardian Printed Name Signature and Seal of Parish Priest: I hereby affix my signature in approving this child s Camp Application, signifying his/her good standing in our parish. Signature of Parish Priest

5 CAMP GUIDELINES AND REGULATIONS FOR PARENTS AND CAMPERS Please note that this form must be read and signed by both the camper and the parent. Applications will not be considered if this form is not signed and returned. 1. Camp strictly prohibits camper cars, alcoholic beverages, illegal drugs, tobacco products, fireworks, or weapons of any kind. If your child is found having any of the above, he/she will be sent home immediately. 2. Camp is an Orthodox Christian Camp for youth. Thus, any inappropriate, violent/aggressive, or unchristian behavior may result in your child(ren) being sent home immediately; these behaviors include, but are not limited to: Attacking or hitting another camper, counselor, camp worker, or camp director. Inappropriate touching or fondling of another camper (male or female) or counselor. Disrespectful behavior (swearing, cursing, yelling in anger, use of shaving cream, or other substances) shown toward campers, counselors, director or workers. Leaving the barracks at night after lights out to sneak over to the other barracks (boys to girls or vice versa), whether your child is caught in the act or not. Food, candy, or drink in the barracks. Snacks are permitted only during free time and not in the barracks. Cell phones, ipods, radios, stereos, boom boxes, walkman tape players, and walkie-talkies are not allowed at Camp. This will be strictly enforced. Disrespect shown during the Church services including laughing, talking, or not participating will necessitate one warning, then dismissal. Use of camp phone for social calls. Theft of camp property. Destruction of camp property (bunks, lockers, doors, shower fixtures, windows, etc.) will not be tolerated. This includes picnic Sunday. If your child(ren) are involved in any of this, you will be held financially responsible and your child(ren) will not be permitted back to Camp the following year. Barracks should be kept neat and presentable by campers. Please stress to your child(ren) to be respectful of the camp property. We reserved the right to search luggage, lockers and bed areas at any time. Camper please note: In signing below, you agree to adhere to the rules and guidelines of St. Sava Camp. Camper s signature: Parents please note: In signing below, you are agreeing that your child(ren) will adhere to the rules and guidelines of. Your endorsement is your consent for inspection of prohibited articles. Your signature also affirms that you have gone over these items with your child(ren). Your child(ren) s application will not be considered unless this form is signed and returned to us. Parent s signature:

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