Marianne Askew and Sally Joyce
|
|
|
- Gertrude Logan
- 5 years ago
- Views:
Transcription
1 Dear Friend, Thank you for your interest in Camp Hope Camp Hope s mission is to create a healing environment for those living with cancer by fostering meaningful relationships with others through shared experiences, relaxation and fun. Camp Hope is presented by Northside Hospital-Atlanta Auxiliary, in cooperation with the Northside Hospital Cancer Institute. It will take place on April at Camp Twin Lakes in Rutledge, GA. The weekend is free to all participants and transportation is provided from Northside Hospital-Atlanta to and from Camp Twin Lakes. If you are interested in joining us for Camp Hope, please fill out the application and return it as soon as possible as our openings fill up quickly. Camper acceptances are contingent on a phone interview with an oncology nurse and are on a first come first served basis, with priority given to Northside Hospital Cancer Institute patients. Applications will not be accepted after March 25, Northside Hospital-Atlanta Auxiliary, Attention: Camp Hope 1000 Johnson Ferry Rd NE, Ste. 961 Atlanta, GA, Fax: camphopeatl@gmail.com for questions carol.kratochvil@northside.com for completed applications We hope that you will choose to be a part of Camp Hope, and look forward to hearing from you soon! Sincerely, Marianne Askew and Sally Joyce Marianne Askew and Sally Joyce Camp Hope Co-Chairs Northside Hospital-Atlanta Auxiliary 1
2 An Adult Cancer Retreat sponsored by Northside Hospital-Atlanta Auxiliary For further information call Our Mission Statement: The mission of Camp Hope is to create a healing environment for those living with cancer by fostering meaningful relationships with others through shared experience, relaxation and fun. We are not meant to make the journey alone. What is Camp Hope? Camp Hope is a full weekend adult cancer retreat offered at no cost to participants. The retreat is alcohol free and smoke free and features entertainment and many fun activities. Who sponsors the retreat? Camp Hope is a community outreach project sponsored by Northside Hospital Atlanta Auxiliary. It is made possible through volunteer fund-raising projects. Who can attend? A Camper must be 18 or over, diagnosed with cancer, no more than one year out of treatment, and must be ambulatory and independent. Northside Hospital patients will have priority. Who is the Staff? Retreat personnel include members of Northside Hospital Auxiliary, previous campers/buddies and professional staff from Northside Hospital. Where is the Camp located? The retreat is located at Camp Twin Lakes in Rutledge, GA. All rooms are air-conditioned and sleeping accommodations are double occupancy. Roommates will be assigned. How do I get there? Bus transportation to and from Camp Hope is provided by the Northside Hospital-Atlanta Auxiliary. 2
3 NORTHSIDE HOSPITAL AUXILIARY-ATLANTA CAMPER APPLICATION APRIL 12-14, 2019 TODAY S DATE: GENERAL INFORMATION (please print clearly) Last Name First Name Preferred Name Gender Birth date Cell Phone Street Address City Zip Emergency Contact Name Cell Phone Relationship CAMP INFORMATION The following information will help us make sure you are able to enjoy your time at Camp Hope. Diet: Food allergies: Food preference: (vegetarian etc.) Activity: Bedtime: Shirt sizes: Do you use a walker or cane? Able to get in and out of a bathtub? Can you walk one block without stopping? How many times/day can you climb 20 stairs? 1 time / 3 times / more (Circle or write in #) Do you have a C-Pap or Do you snore? Use oxygen? Other sleep habits: Bi-Pap? T-shirt (please circle): S M L XL XXL XXXL Sweatshirt: (they run large) S M L XL XXL XXXL Since Camp Twin Lakes is a place primarily for children and there will be children using other areas of the facility when we are there, for their safety, we are required to run an online background check on the National Sex Offender s Registry (NSOR) for all participants of Camp Hope. Any report that indicates any activity other than fully clear will be shared with the Camp Twin Lakes Camp Director before that individual will be allowed to participate on the camp property at Camp Twin Lake s decision. I give my permission for my physician/mid-level provider to provide any additional information for my participation in Camp Hope. Signature Date 3
4 MEDICAL INFORMATION Cancer Diagnosis: Are you currently in treatment? If yes, what kind of treatment? Chemo Radiation Physician s name: MEDICATION ALLERGIES Cancer stage: Date of treatment closest to April 11th Treatment location: TYPE OF REACTION BEE STING ALLERGY If yes, do you have a prescription for an EPI pen? OTHER MEDICAL CONDITIONS Current (like an infection) and chronic (long term like diabetes) MEDICATION LIST (if you need more space, use a separate sheet of paper) Name of medication Reason taking Dose Times of day Date of last Tetanus or Tdap vaccine: Important Note: If you have allergies or asthma, you MUST bring your own epi pen and inhaler(s) and carry them with you AT ALL TIMES during camp. 4
5 TO BE COMPLETED BY PHYSICIAN OR MID-LEVEL PROVIDER Care Provider Authorization: By signing this form, you are telling us that, in your opinion, this person is both physically and emotionally ready to participate at Camp Hope Friday, April 12-Sunday April 14, The following restrictions apply to my patient (if none, so state): These medications are stocked in Camp Hope s infirmary and will be used to manage illness or injury. All OTC medications will be administered per instructions on package. Please cross out medications that are contraindicated for this patient. Medications Conditions OTC Medications Systemic Medications Topical Medications Allergies Congestion Fever/pain Menstrual pain Heartburn Constipation Headache Diarrhea Upset stomach or diarrhea Minor wounds Itchy or irritated skin Sunburn Bug bites Eye irritation Diphenhydramine 25mg (Benadryl) Sudafed 30 mg (Pseudoephedrine HCl) Acetaminophen 500mg (Tylenol) Ibuprofen 200mg tablets (Advil) Calcium Carbonate USP 750mg (Tums) Polyenthylene glycol 3350 (MiraLAX) Acetaminophen 500mg (Tylenol) Ibuprofen 200mg (Advil) Loperamide HCl 2mg Pepto-Bismol (Bismuth subsalicylate) Hydrogen peroxide Bacitracin ointment Neosporin ointment Hydrocortisone 1% ointment Burn relief, 0.5% lidocaine gel Broad spectrum SPF 50 sun screen Bug spray Hydrocortisone cream Eye wash Care Provider s (MD/APP) Signature Date Printed Name Send completed application by March 25, 2019 to: carol.kratochvil@northside.com fax
Please circle shirt size and check Youth or Adult: Shirt Size S M L XL XXL 3XL other: 4-H Member is active in 4H Online:
2019 4-H Special Clovers Registration Packet March 23 & 24, 2019 DEADLINE: Registration is due in the State Office February 1 st Camp is limited to the 1 st 15 paid 4-H members Date: / / 2019 FOIC USE
MARYLAND 4-H CAMPS HEALTH FORM
MARYLAND 4-H CAMPS HEALTH FORM Camper s Name: _ Last First MI Nickname Current Photo Of Camper Male Female Age at Camp Arrival: Birthdate: Dates will attend Camp: to Street Address City State ZIP County
Dates will attend camp: from to Month/Day/Year Month/Day/Year. Male Female Birth Date Age on arrival at camp Month/Day/Year
CAMPER HEALTH-CARE RECOMMENDATIONS by LICENSED MEDICAL PERSONNEL FORM 2 Developed and reviewed by: American Camp Association, American Academy of Pediatrics Council on School Health, & Association of Camp
CAMPER HEALTH HISTORY FORM 1
CAMPER HEALTH HISTORY FORM 1 Developed and reviewed by: American Camp Association, American Academy of Pediatrics Council on School Health, & Association of Camp Nurses Mail this form to the address below
CAMPER HEALTH HISTORY FORM 1
CAMPER HEALTH HISTORY FORM 1 Developed and reviewed by: American Camp Association, American Academy of Pediatrics Council on School Health, & Association of Camp Nurses Mail this form to the address below
Summer 2017 Health Form Break Down
Summer 2017 Health Form Break Down The health and safety of campers are our primary concern. As such, we review and update our Health Forms each year to reflect changes made in Maryland State Youth Camp
Date Camper Name: LAST, FIRST (Please print) Medical Form
Date Camper Name: LAST, FIRST (Please print) Medical Form Medical information must be provided for you or your child to attend camp. To ensure the health and safety of our volunteer staff, adult and youth
CAMPER HEALTH HISTORY FORM1
CAMPER HEALTH HISTORY FORM1 Developed and reviewed by: American Camp Association, American Academy of Pediatrics Council on School Health, & Association of Camp Nurses Mail this form to the address below
Camper Health History form must be on file prior to arrival at NEMC
Dear NEMC Parent: Camper Health Form It is our privilege to care for your child while they are at camp. In order to do so safely and effectively, we ask that you use the checklist below to assure that
Parent Information for Health Services YMCA STORER CAMPS
Parent Information for Health Services YMCA STORER CAMPS Our health service practices are shaped by regulations and/or guidelines from entities such as American Camp Association, Association of Camp Nurses,
Camp Fire Georgia / Camp Fire Camp Toccoa Camper Medical and Health History
First Name: _ Last Name: Camp Fire Georgia / Camp Fire Camp Toccoa Camper Medical and Health History Attending Camp Session(s) 1 2 3 4 5 6 7 8 LIT CIT Intern Staff The information on this form is not part
Children s Camp 2018 Registration
Children s Camp 2018 Registration Complete all Forms and submit all paperwork with FIRST PAYMENT! Be sure to mark each fee applicable even if only making an initial deposit. Camper s Name: Grade: Kidz
CAMP JEANNE D ARC Medical Information Instructions for Parents/Guardians
CAMP JEANNE D ARC 2018 Medical Forms 2017 Medical Information Instructions for Parents/Guardians DUE to bybunk1 MAY or 1, mail 2017to our office by May 1st Please complete and upload Complete online: Registration
Peterkin Camp and Conference Center
Camper Information Peterkin Camp and Conference Center A Ministry of the Episcopal Diocese of West Virginia Summer Camp Registration Please complete one form per camper per camp. Check which camp your
Lake Geneva Youth Camp Health Certificate
Lake Geneva Youth Camp Health Certificate Camp Session This health form must be completed by the parent or legal guardian of the camper, and signed at the bottom. This form must be returned to the Camp
SIBLING/FRIEND APPLICATION 2013
SIBLING/FRIEND APPLICATION 2013 To be filled out by the parent/guardian of the friend/sibling. PERSONAL INFORMATION Name of Camper: Name of Primary Camper that he/she will be accompanying: Relationship
2015 Camper Health Form
2015 Camper Health Form Camp Frederick PO Box 258, 6996 Millrock Road, Rogers, OH 44455 Email: info@campfrederickohio.com Phone: 330-227-3633 FAX: 330-227-9005 Camp Frederick requires the following information
2019 Registration Form
Please include a $50 NONREFUNDABLE DEPOSIT for each camp. Please complete a separate form for each camper. For Office Use Only Please Print Legibly Parent/Guardian Information Relationship to Camper Relationship
MARYLAND 4-H CAMPS HEALTH FORM
MARYLAND 4-H CAMPS HEALTH FORM Last First MI Nickname Current Photo Of Camper Male Female Home Address: Age at Camp Arrival: Birthdate: MM/DD/YYYY Dates will attend Camp: to MM/DD/YYYY MM/DD/YYYY Street
Southern California 401 S. Ivy Street Escondido, CA (P) (F) 2018
= Easterseals Southern California 401 S. Ivy Street Escondido, CA 92025 951.264.4855 (P) 760.406.6048 (F) 2018 www.easterseals.com/southerncal Dear Campers and Parents Easterseals camp will be held August
As the parent/guardian of I choose not to have a medical. Personnel FORM 2.
Star Lake Camp Health Form 2017 All Campers must have a signed CAMPER HEALTHHISTORY FORM 1 on file at camp. Please be sure to send it with them. All campers must have a Recommendations for Licensed Medical
Page
Page 1 Page 2 Page 3 Page 4 WE ARE ACA ACCREDITED! (AND PROUD!) Page 5 Page 6 º º º º Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 º Page 18 Page 19 Page 20 Page
YMCA Hayo-Went-Ha Camps Instructions for Medical Form
YMCA Hayo-Went-Ha Camps Instructions for Medical Form EFFECTIVE JANUARY 01, 2012, THE AMERICAN CAMPING ASSOCIATION HAS CHANGED THE STANDARD FOR A CAMPER S HEALTH EXAM. CAREFULLY READ THE INFORMATION BELOW!
PARENT / GUARDIAN: PLEASE FILL OUT AND SIGN THIS PAGE.
CAMPER HEALTH Attending: 1st Session 2nd Session (Circle one) HISTORY FORM 2015 Camper Name: Developed and reviewed by: American Camp Association, First Middle American Academy of Pediatrics Council on
Camp St. Charles ANNUAL HEALTH FORM CHECKLIST
Camp St. Charles ANNUAL HEALTH FORM CHECKLIST Parents, please use this handy checklist to help you organize your child s health information and prepare everything that needs to be mailed to Camp. HEALTH
Please mark which days your camper will be attending. ($15 a day or $70 for all week)
Peterkin Camp and Conference Center A Ministry of the Episcopal Diocese of West Virginia An Accredited American Camp Association Camp Day Camp Registration June 18-22, 2018; Open to youth entering K-6
SUMMER AT THE YMCA 2019 Health History Form
SUMMER AT THE YMCA 2019 Health History Form This form must be filled out completely, signed by the camper s parent/guardian, and returned with requested documentation to the camp office or YMCA Branch
HEALTH FORMS PHYSICIAN
HEALTH FORMS PHYSICIAN Form must be completed AND signed by a licensed health-care provider. Please review the HEALTH FORMS and complete all sections of this form. Fax this form, by June 1 st, to (607)
SUMMER AT THE YMCA 2018 Health History Form
SUMMER AT THE YMCA 2018 Health History Form This form must be filled out completely, signed by the camper s parent/guardian, and returned with requested documentation to the camp office or YMCA Branch
Eastman Area 4-H Summer Camp
Eastman Area 4-H Summer Camp It s not too soon to be thinking about summer camp! Eastman Area will once again be holding a summer camp for Junior and Intermediate members, from August 25 th -30 th at beautiful
Camp Zanika Required Camper Forms
Camp Zanika Required Camper Forms Every camper attending Camp Zanika must have a copy of the required forms. Forms can be found on our website, emailed, or mailed. All forms need to be returned to the
NetXtreme Intro Sheet
NETX YOUTH CAMP P.O. BOX 27 MAUD, TX 75567 For registrations after the deadline or other questions about registration call: 903.585.2569 fax: 903.585.9772 email: info@netxtreme.org www.netxtreme.org NetXtreme
San Marino Service Unit presents Twilight Camp 2017
San Marino Service Unit presents Twilight Camp 2017 THE TRADITION CONTINUES..SINCE 1935! A classic Girl Scout Day Camp Program 100% Volunteer Run by Parents and Older Girl Scouts Join us for another fabulous
Camper Information. Street Address Apartment/Unit # City State ZIP Code. Parent/Guardian Information. Last First M.I. City State ZIP Code
Health History Form Parents / Guardians must complete all sections of this form apart from the final section which should be completed by the campers physician or a licensed medical personnel. Camper Information
Camp Hands Up 2018 Registration Form **Please Note: Prices are changed and see on the bottom**
Camp Hands Up 2018 Registration Form **Please Note: Prices are changed and see on the bottom** Participant Questions (Required) = * *First & Last Name *Date of Birth *Gender: Male or Female *Grade: *Email
Please return this form to your hosting branch.
CAMPER HEALTH HISTORY FORM 1 Developed and reviewed by: American Camp Association, American Academy of Pediatrics Council on School Health, & Association of Camp Nurses Please return this form to your
Camp Celo. Medical Form Package Instructions:
Camp Celo 775 Hannah Branch Road Burnsville, NC 28714 828-675-4323 Medical Form Package Instructions: These forms are required of all campers. Please complete and return by May 15. 1. Complete and sign
ESO Summer Camp 2018
ESO Summer Camp 2018 Dear Parent/Guardian: We are so glad you are interested in attending ESO Summer Camp at the Barber National Institute. Attached is the 2018 ESO summer camp Application Packet. WE WILL
CAMP I BELIEVE: CAMPER APPLICATION Camp Baldwin Elberta, AL Saturday, September 12 th -Sunday, September 13 th, 2015
CAMP I BELIEVE: CAMPER APPLICATION Camp Baldwin Elberta, AL Saturday, September 12 th -Sunday, September 13 th, 2015 CAMPER INFORMATION Last First Middle Nickname _ Street Apt# City State Zip DOB Age Grade
Ben Lomond Quaker Center Summer Youth Camps Box 686, Ben Lomond, CA (831) ENROLLMENT FORMS
ENROLLMENT FORMS THESE FORMS MUST BE COMPLETED AND POSTMARKED NO LATER THAN JULY 2ND OR FAXED TO 831-336-0218 EQUIRED EMERGENCY INFORMATION Please PRINT legibly Camper's Name Sex: M F Birth date: / / Social
Overnight Camp 2018 Camper Information and Medical Form
Overnight Camp 2018 Camper Information and Medical Form Day camper medical form, other registration forms and/or online registration are available at www.circlerranch.ca This form must be submitted to
Overview. Camper Confirmation Packet Easter Seals Washington Camp Stand By Me
Camper Confirmation Packet 2015 Email: campadmin@wa.easterseals.com Overview Welcome to the 2015 Season at Easter Seals Camp Stand by Me! This packet includes important paperwork that we need on file here
Duffield Camp and Retreat Center Challenge Camp Application & Registration Form
1 Duffield Camp and Retreat Center Challenge Camp Application & Registration Form Camp Start Date and Time: July 7th arrival 2pm Pick up Date and Time: July13th at 10am Mail completed form to: Duffield
14248 F Manchester Road, PMB #310 Manchester, MO 63011
February 15, 2014 Dear Parents and Campers, Gateway Hemophilia Association is excited to announce Camp Notaclotamongus 2014, for children with bleeding disorders! Camp will be held Wednesday, June 4 th
CAMPER APPLICATION CAMP DRAGONFLY September 23 & 24, 2017
CAMPER APPLICATION CAMP DRAGONFLY September 23 & 24, 2017 Registration Deadlines Return Campers: Aug 1st New Campers: September 11th (Please use only black or blue ink and complete all information) Camper
2017 Houchens Day Camp
2017 Houchens Day Camp Registration Deadline: May 15, 2018 Limited to first 100 paid registrations Location: Houchens Program Center on Barren River Road, Bowling Green, Kentucky Dates: June 11-14th with
Girl Scouts of Western Washington Community Camper Health History & Consent to Treat
Girl Scouts of Western Washington Community Camper Health History & Consent to Treat Camper s Full Name: Date of Birth: Girl Scout Camp Attending: Camp Lyle McLeod Camp St Albans Northern Property Community
We thank you for your interest in Easterseals camp. Should you have any questions, please contact me at or
2017 Dear Parents and Campers, Easterseals camp will be held August 6th through August 12th at YMCA Camp Oakes in the San Bernardino Mountains. Our theme will explore science fiction and be called "Sci-Fi
HEALTH FORMS PHYSICIAN
HEALTH FORMS PHYSICIAN Form must be completed AND signed by a licensed health-care provider. Please review PARENT/GUARDIAN FORMS 1 & 2, and complete all sections of this FORM. CAMPER NAME: Date of Birth:
Complete registrations & payment may be mailed to: INUMC, Attn: Camp Registration, 301 Pennsylvania Parkway - Suite 300, Indianapolis, IN 46280
Complete registrations & payment may be mailed to: INUMC, Attn: Camp Registration, 301 Pennsylvania Parkway - Suite 300, Indianapolis, IN 46280 REYOAD and Camp 139 Registration Form - 2018 Camp REYOAD
Shepherds Camp 2011 Arrowhead Bible Camp Brackney, Pennsylvania
Shepherds Camp 2011 Arrowhead Bible Camp Brackney, Pennsylvania Application & Registration Form Office Use Only Rec d: Medical: Amount: # E: C: Camper Age M F DOB / / Address Phone ( ) - City State Zip
2017 Medical Form Carolina Raptor Center Summer Camp
2017 Medical Form Carolina Raptor Center Summer Camp Health Information, Form 1 Camper s Name: Birthdate: Sex: Street Address: City State Zip _ 1st Parent/Guardian: Mobile Phone: Home Phone: Work Phone
Southern California 401 S. Ivy Street Escondido, CA (P) (F)
= 2015 Creating solutions, changing lives. Services for children and adults with disabilities in Southern California Easter Seals Southern California 951.264.4855 (P) 760.406.6048 (F) www.easterseals.com/southerncal
CAMPER REGISTRATION FORM, SUMMER CAMP, 2015
CAMPER REGISTRATION FORM, SUMMER CAMP, 2015 FOR GRADES 3-12 (separate forms for Uno & Family Camps) Christian Church (Disciples of Christ) in Florida RETURN COMPLETED FORMS AND PAYMENT TO The Retreat at
KIDDO CAMP PACKING LIST
KIDDO CAMP PACKING LIST WHAT TO PACK IN 22 GALLON (or smaller) Plastic tub with lid -- LABEL with your child's first and last name please!! WHAT TO BRING Sleeping bag, or twin sheets and cover Pillow and
The Salvatio n Army Kim Schwich PO Box 182 Green Isle, MN
2018 Camper Application The Salvatio n Army Kim Schwich PO Box 182 Green Isle, MN 55338 Kim_Schwich@usc.salvationarmy.org CAMP SESSIONS ATTENDING OFFICE USE ONLY Date Received: Complete YD Initial: Name:
FORM /GUARDIAN PLEASE HEALTH PARTICIPANT PROGRAM PARTICIPANT HEALTH FORM, CONT. TO BE COMPLETED BY PHYSICIAN ARENT/G CAMPER
GLOW YMCA CAMP HOUGH PARTICIPANT HEALTH FORM TO BE COMPLETED BY PARENT ARENT/G /GUARDIAN PLEASE TE THE NEED FOR PHYSICIAN HYSICIAN S S SIGNATURES ON BOTH SIDES OF THIS FORM ORM. T ALL YMCA SUMMER PROGRAMS
Summer Camp Application Fax completed form to OR Print and mail to 4443 Grave Run Rd., Manchester, MD 21102
Summer Camp Application Fax completed form to 443-712-1015 OR Print and mail to 4443 Grave Run Rd., Manchester, MD 21102 _ Camper s Last Name First Name Middle Initial _ Grade Completed ( as of June) Birth
Harvest Kidz Camp 2016
DO NOT STAPLE USE PAPER CLIP PLEASE PRINT CLEARLY Camper s Information Last Name First Name Harvest Kidz Camp 2016 CAMPER REGISTRATION FORM Middle Social Security Number Date of Birth Age Gender Male Female
2019 CAMP WARWICK R EGISTRATION FORM
2019 CAMP WARWICK R EGISTRATION FORM THIS FORM MUST BE COMPLETED BY PARENT/ GUARDIAN AND SUBMITTED WITH PAYMENT AND OTHER REQUIRED DOCUMENTS BEFORE REGISTRATION WILL BE ACCEPTED. THE PERSON REGISTERING
Residential campers will report Sunday evening, and parents need to pickup Friday afternoon
Thank you for registering your child to attend our fun-filled summer camps. Our camps are packed with many opportunities to learn, make friends with other Deaf or Hard of Hearing kids, and explore outlets
IMPORTANT NEMC CAMP FORMS
IMPORTANT NEMC CAMP FORMS Please print this page, read the Parent/Camper Handbook, complete the checklist of forms, and mail to the camp address or email office@nemusiccamp.com by June 1 st. Travel Form
Creating solutions, changing lives. Services for children and adults with disabilities in Southern California
2015 Creating solutions, changing lives. Services for children and adults with disabilities in Southern California Easter Seals Southern California 401 S. Ivy Street Escondido, CA 92025 951 264 4855 (P)
Camp Paradise Registration (Required) - Due April 7, 2014 Page 1
Youth Camp Paradise Registration (Required) - Due April 7, 2014 Page 1 Name of Camper: Ma le Female Camper s Address: Street City/State Zip County Phone: Date of Birth: Name of Buddy if attending Week
Cave Springs Camp Registration Form
Cave Springs Camp Registration Form Camper Information (please use one form per camper) Camper s Name: (Last) (First) Birthday: (D/M/Y) Age: Gender: Does your child require 1:1 support? Yes No (Please
FEE. (circle one) T-Shirt Size: XXL. Height: Weight: Phone Number: Relationship: $375 $400 $25. Non-CPI Participant. Transportation $25) $75 $10
Camp Partnerships Application 2018 This information is EXTREMELY important in helping to provide a safe and enjoyable time for each camper. Pleasee answer ALL questions completely and honestly. If ALL
Episcopal Diocese of Northwest Texas
Episcopal Diocese of Northwest Texas Summer Camp Program 2018 Who Dat Saint?: Stories of Some Heroes of the Faith! Camp Quarterman Camp Quarterman Jr. June 10-16 June 24-30 Completed grades 7 th -12 th
Mountainview Christian Camp Youth Events Registration A checklist to help:
Youth Events Registration A checklist to help: Camper age, Grade and emergency numbers filled out Parent/legal guardian signature ALL immunization dates (please state if there are none) Doctor s telephone
Girl Scouts of Area 10 Day Camp June 18-22, :30 a.m. 3:30 p.m. Camp Shantituck Shepherdsville, KY Registration Opens March 15
Girl Scouts of Area 10 Day Camp June 18-22, 2018 8:30 a.m. 3:30 p.m. Camp Shantituck Shepherdsville, KY Registration Opens March 15 Do you have some time you can give to camp? This camp is staffed by volunteers
2019 FAMILY CAMP Camper and Adult Registration
2019 FAMILY CAMP Camper and Adult Registration Christian Church (Disciples of Christ) in Florida RETURN COMPLETED FORMS AND PAYMENT TO The Retreat at Silver Springs, 6455 E. Silver Springs Blvd., Silver
2018 CAMP PUGWASH BLIND CAMP APPLICATION INSTRUCTIONS
Maritime Conference of the Seventh-day Adventist Church Inc. Camp Pugwash 2018 2171 Gulf Shore Road Pugwash NS B0K 1L0 902.243.2097 2018 CAMP PUGWASH BLIND CAMP APPLICATION INSTRUCTIONS MAIL $50 NON-REFUNDABLE
2018 Medical Waiver and Release
2018 Medical Waiver and Release I hereby give my consent to the Summer Camps at Avon Old Farms School personnel to provide, through a medical staff of its choice, customary medical attention and emergency
Day Daily Them Subject Bible Study Focus Objective Craft focus (additional) John the Baptist calling out, prepare the way!
What Time is it? Summer 2014 overview Ecclesiastes 3:1 For everything there is a season, and a time for every matter under heaven. Day Daily Them Subject Bible Study Focus Objective Craft focus (additional)
KMC 24 th Annual Dance Camp 2017
KMC 24 th Annual Dance Camp 2017 July 10 th -14 th at Cannon Falls Campground Cost is $410 due by May 13 th. Cash or Checks only. Checks will not be cashed until after May 15 th. Please fill out the white
LAKE OF THE OZARKS BAPTIST ASSOCIATION 2018 CAMPER APPLICATION
LAKE OF THE OZARKS BAPTIST ASSOCIATION 2018 CAMPER APPLICATION LAKE OZARK/PULASKI JR HIGH/YOUTH CAMP CAMP FEE $85.00 MUST HAVE COMPLETED Grades 6-12 JULY 23, 1:00 P.M. - JULY 27, 2:00 P.M. DO NOT ALTER
Day and Resident Camp
Day and Resident Camp CAMPER NAME: BIRTHDAY: / / AGE AT CAMP: GENDER: M F ADDRESS: CITY: STATE: ZIP: PARENT/GUARDIAN S NAME: HOME/WORK/CELL PHONE: EMAIL: COUNTY: ETHNICITY: TRANSPORTATION/BUS SITES Car
Overnight Camp Registration
over ---> Summer 2019 Overnight Camp Registration Additional registration forms and/or online registration available at www.circlerranch.ca Camper Information: Male New Camper (Camper s last name) (Given
Winter Resident Camp December Winter Day Camp at Immokalee December :30am - 6:30pm
Winter Resident Camp December 26-30 Winter Day Camp at Immokalee December 27-29 6:30am - 6:30pm CAMP IMMOKALEE Program Handbook Staff Our Camp Immokalee staff is dedicated to making your child s Winter
GARAYWA CAMP & CONFERENCE CENTER 2018 Summer Missions Camp Registration Form
GARAYWA CAMP & CONFERENCE CENTER 2018 Summer Missions Camp Registration Form A FULL PAYMENT OF $185 PER CAMPER MUST BE MAILED ON OR AFTER JANUARY 4th WITH THIS COMPLETED REGISTRATION FORM TO Garaywa Camp
RUNNING CAMP. Sunday Aug. 7 Saturday Aug.13, Sponsored by Asics America
RUNNING CAMP Sunday Aug. 7 Saturday Aug.13, 2011 Sponsored by Asics America Location: Camp Varsity Running Camp is located in the beautiful Blue Ridge Mountains of Madison, Va. Different types of running
Camp Courage I May 17-19, 2019 Pre-Camp May 6, 2019 Camp Courage II October 4-6, 2019 Pre-Camp September 23, 2019
Dear Prospective Camper and Parent/Guardian: We are so pleased that you are considering Camp Courage as a way of supporting your child in dealing with the death of a significant person in their lives.
Camper s Name Last First Middle Date of Birth Age Today s Date. Mailing Address City State Zip County Sex Race
For Arc Use Only Application for 2018 Day Camp 546 S. Collett Street, Lima, Ohio 45805 Phone: 419-225-6285 Please fill out this application completely Any incomplete application will be returned to you
Camper Authorization for Medical Treatment and Authorization to Pick-up Camper
Camper Authorization for Medical Treatment and Authorization to Pick-up Camper Please return all 5 forms at least week before your first day of camp to: Inside the Outdoors, 200 Kalmus Dr., Costa Mesa,
2013 BFA Jr. Balloonist Hot Air Balloon Camp Camp Registration Form Reno, Nevada
2013 BFA High Sierra Balloon Camp Western States Region Balloon Federation of America Jeff Haliczer, Director 15225 Pinion Dr. Reno, Nevada 89521-8841 Home Phone: (775)853-4109 Camp E-mail: Renoballooncamp@sbcglobal.net
Rocky Mountain Orthodox Youth Camp RMOYC. Information Sheet
Rocky Mountain Orthodox Youth Camp RMOYC Information Sheet Please keep this sheet as a reminder of Camp Details! 1. Dates: NEW THIS YEAR TWO CAMP SESSIONS! We are experimenting with two sessions this year
CAMP PEP APPLICATION 2018
Page 1 of 12 CAMP PEP APPLICATION 2018 Programs Employing People 1200 S. Broad St, Philadelphia, PA 19146 Phone: (215) 389-4006 FAX: 215-389-5228 E-mail: info@pepservices.org INSTRUCTIONS FOR COMPLETING
South Shore Stars 2015 Summer Camp and Fall Enrollment
My child is in the grade, and attends After School Program. South Shore Stars 2015 Summer Camp and Fall Enrollment Child s Name(s) Parent s/guardian s Name Home Phone Work Phone Email Address Your child
Crex Meadows Youth Conservation Camp. Camper Application Form. First Last M.I. Date of Birth Age Gender
Name Crex Meadows Youth Conservation Camp Camper Application Form First Last M.I. Date of Birth Age Gender Expected Graduation Year Current Grade Level School Attending Social Security Number / / (for
Area 14 Day Camp 2019 Celebrating You
Area 14 Day Camp 2019 Celebrating You June 24-28, 2019 Camp Shantituck Training Dates for volunteers and AIDEs May 19, June 24 @Camp Shanituck Based upon the interests of the campers the possibilities
Tennessee Valley Railroad Museum Rail Camp
Tennessee Valley Railroad Museum Rail Camp Please complete ALL information and return by May 1st. Incomplete forms will not be processed. Camper Name: Preferred Name: (First Name) (Middle Initial) (Last
Camper Forms Checklist-Camp Menzies
Camper Forms Checklist-Camp Menzies If you have difficulty opening the forms, contact customer care at 916.452.9181/800.322.4475 or customercare@ Forms Tips Use the following checklist and review the information
Camp Spectacular 2018 Application
Camp Spectacular 2018 Application SESSION PREFERENCE New camper All new campers must participate in a pre-camp screening. Contact the camp office to schedule an appointment. Returning camper Years of attendance:
July 6-8, 2017 Texas 4-H Conference Center
July 6-8, 2017 Texas 4-H Conference Center Thank you for your application to Mission Possible! To ensure we can adequately meet each campers needs, please complete this form and return either by mail to
Camper Application. Legal Guardian #1 Information. Legal Guardian #2 Information: Family Status: Mailing Address: Address: City: State: Zip:
Camper Application Legal Guardian #1 Information First Name: Last Name: Relationship to Camper: Home Phone: Cell Phone: Work Phone: E-mail: Legal Guardian #2 Information: First Name: Last Name: Relationship
YMCA Camp Seymour Camper Release Form
YMCA Camp Seymour Camper Release Form This document identifies people who are authorized to pick-up and/or be contacted regarding the below-named child. Persons listed on this form are understood to be
Camper Name: Male Female First M.I. Last Camper T-shirt Size: Grade in Fall 18. Date of Birth (MM/DD/YY): Age at Camp: Name to go by at camp:
Peterkin Camp and Conference Center A Ministry of the Episcopal Diocese of West Virginia Overnight Youth Camp Registration 2018 Please complete one form per camper per camp. Check which camp your camper
Pages 2-3 Registration Parent/Guardian complete for Please be sure to complete section in blue regarding All Camper s camper family picnic on Sunday
CAMP CELEBRATE 2018! Dear Camper s and Parents, It is once again time for Camp Celebrate and we are super excited! You will find the Registration Packet attached to this letter. There are a number of pages,
MORE INFORMATION FOR PARENTS Check out the Questions and Answers page of our website. Click on the Summer Camps tab, then For Parents.
Kinder Camp Information Hello from Camp Luther! We have received your Kinder Camp registration and are eager to share our summer with you! The following is essential information; please read it carefully.
GARAYWA CAMP & CONFERENCE CENTER 2019 Summer Missions Day Camp Registration Form
GARAYWA CAMP & CONFERENCE CENTER 2019 Summer Missions Day Camp Registration Form REGISTRATION OPENS JANUARY 3, 2019 A FULL PAYMENT OF $25 PER CAMPER PER DAY MUST BE MAILED WITH THIS COMPLETED REGISTRATION
Sailing Camp Information
Sailing Camp Information Hello from Camp Luther! We have received your Water Ski Camp registration and are eager to share our summer with you! The following is essential information; please read it carefully.