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3 RevolutionCamp.org Registration Details Check in Registration on the first day of camp is from 4:00-6:00 pm. You may pay your camper s balance by check. Please make all checks payable to Victory Church. To expedite registration, church groups should pay with one check. Once your group is checked in on Wednesday, head outside for the Revolution Camp Kick Off Party! Check Out On the last day of camp, we will dismiss between 11:00-11:30 am. Rooms must be cleaned out and all items removed. We are not responsible for lost items or items left at camp. Meals Meal times will be served at 8:00 am, 12:30 pm, and 6:00 pm. The snack bar will be open three times a day for campers to purchase candy, drinks, etc. Some tickets for FREE concessions will be in the camper s welcome bag. We recommend sending $2-$4 per day for concession purchases. No lunch will be served on Saturday. Medication/Special Medical Requests Please be sure to complete and sign the Youth Camp Medication Form if your child needs to take any kind of prescription medication while at camp, or if there are any special needs that our nurse should be made aware of. Asthma Inhalers are the only form of medication that the camper will be allowed to keep with them. Please send two in case one is lost. All medication must be in the original container. The Medication Form cannot be signed prior to 24 hours before camp. Security & Phone Policy We are fully aware of our great responsibility in the care of your child. In the case of an emergency, you will be notified immediately. Incoming calls are not allowed, except in cases of emergency, out of consideration for other campers and planned activities. We will maintain 24 hour security staff and access is restricted to workers and campers. Camp Policies By registering for camp, you agree to abide by all rules set forth by the Victory Church Int l., Inc., Revolution Youth Camp and the Camp Director. Serious offenses such as possession of banned substances (drugs, alcohol, tobacco, firearms, etc.) shall be met with immediate dismissal from camp and will be reported to local authorities. Anyone who leaves the camp without approval of the Camp Director will be dismissed from the camp upon their return. In addition, local authorities will be notified. We restrict the use of vehicles operated by campers who provide their own transportation. No camper will be allowed to leave the property after check-in, unless a parent has contacted our office and made prior arrangements. No hazing of other students will be tolerated. Campers will be required to respect other campers and their property at all times. No electronics, cell phones, CD players, ipods, electronic games, electronic Bibles, etc. will be allowed at camp. Students and their parents/guardians will be held fully responsible for any damage caused to Victory Church Int l., Inc. s property. The Discipline Policy includes: warnings, timeouts, KP duty, work details, etc. Refusal of discipline will result in dismissal from camp. Refunds will not be issued for camp dismissals. Lice Policy: Lice is virtually impossible to treat in a cabin community such as camp. Therefore, if a student is found to have lice, we will have to ask that they be picked up from camp. No refunds will be issued. Please check your student before coming to camp. All campers will be required to wear closed toed shoes during all outside activities. No exceptions! Girls will be required to wear a swimsuit under their clothes during all outside activies to ensure modesty during games involving water.

4 RevolutionCamp.org What to Bring: A good attitude Bible, Pen, Notebook (no electronic bibles or cellphones will be allowed) TWIN sized air mattress OR a sleeping cot Pillow Sleeping bag OR sheets and a blanket Two pairs of closed toed shoes (they will get wet and muddy) Clean, dry shoes for evening services Underwear and socks, bring extra! For Day time - Clothes that can get dirty and muddy (no tank tops or short shorts) Swim Suit/Suits (to be worn under clothing for water games) For Evenings - Regular clothes to wear after shower time (Shower time is after outdoor activities, and before dinner and evening services) Towels and washcloths Modest pajamas Sunglasses/Sunscreen Flashlight Dirty clothes bag Toiletries (shampoo, deodorant, toothbrush, etc.) Medications (to be checked in with the nurse) Spending money for the Concession Stand A few NOTES: -- We are not responsible for lost or stolen items. -- There will be an electronics fast during camp. No cell phones, ipods, games, etc. will be allowed during camp. -- Clothing - Our goal for dress at camp revolves around modesty. Shorts can be worn during the day but must be at least mid-thigh. Athletic shorts or cheerleader shorts like those worn in gym class should not be worn. -- Absolutely NO half shirts, tank tops, sundresses, spaghetti straps, halter-tops, or crop shirts will be allowed. This includes shirts with sides ripped out. No basketball jerseys without undershirts are allowed. All clothing must cover shoulders, back, sides and navels at all times. -- Shoes must be worn at all times. Closed toed shoes must be worn during all outside activities -- No exceptions!! -- Recreation during the day is often messy! When planning what clothes to bring, you will want to bring older clothes and shoes that you can get wet, muddy and dirty! Ladies must wear a bathing suit under their clothing during the outside activities. Pajamas are not allowed for any recreation activities. -- It gets really hot in the summer and you will be spending a lot of time outdoors - Please keep this in mind when packing.

5 RevolutionCamp.org WAYMAKER 2019 Camp Dates: July 7-20, Registration: $90.00 Registration Form and $25.00 Deposit is due by July 1st Registration Includes: Accommodations & Meals, Event T-shirt, & Lots of Fun! Instructions: This form is to be completed by the applicant s parent/legal guardian and signed by parent/legal guardian and camper. You can print a copy and fax or mail it to: Revolution Camp, 6301 E. Parker Rd., Parker, TX or fax it to Make checks payable to Victory Church. info@revolutioncamp.org with any questions. Feel free to make as many copies of this form that you need. Please visit REVOLUTIONCAMP.ORG to download forms or to register online. All information must be complete to be accepted. Camper Information - Please print clearly. Full Name Nick Name Address City State Zip Camper s Cell Phone Camper s c Male c Female Grade Next Fall Date of Birth Age Adult T-Shirt Size Church Name Church City Youth Pastor Pastor Parent/Guardian Information Name Phone Number If Parent/Guardian cannot be contacted, please notify: 1) Name Phone Number 2) Name Phone Number Is there anyone your child should NOT be released to? c Yes c No If yes, Name(s) Medical Information - Please complete fully. Immunizations: Please list last dates given. Oral Polio Rubella DPT Measles Mumps TB Test Check if you have had the following conditions: c Measles c Polio c Chicken Pox c Scarlet Fever c Whooping Cough Chronic/Recurring Conditions: Check all that apply: c Asthma/Respiratory Problems c Bleeding/Clotting Disorder c Hearing Impairment c Ear Infection c Emotional Disturbances c Epilepsy c Fainting c Headaches c Diabetes c Heart Disease c Hypertension c Kidney Disease c Musculoskeletal Disorder c Nosebleeds c Seizures c Sickle Cell Trait/Disease c Special Dietary Program c Other Date of Last Exam: Are any activities restricted? c Yes c No If yes, please explain: Allergies: c Animals c Food c Insects c Medicines c Plants c Pollen c Hay Fever c Other Please list specifics of any allergy checked: Current Medication (please specify): Needed during camp? c Yes c No May be given Tylenol? c Yes c No May be given Benadryl? c Yes c No May be given Ibuprofen? c Yes c No May be given over the counter, non-prescription medications or applications, not to exceed the recommended dosage for stomach discomfort, burns, cuts, insect bites, rash or scrapes? c Yes c No Check if you wear: c Contact Lenses c Glasses c Dental Appliances c Other Application Authorization & Medical Release Can you swim? c Yes c No Physician Name: Phone: Health Insurance: Policy/Group#: This confirms that my child, listed above, has my permission to attend the Revolution Youth Camp sponsored by Victory Church Int l., Inc. I am aware that Victory Church Int l., Inc. or its members will not be held liable in case of accident or injury sustained by my child, loss of articles carried to such function and I hereby agree to release and forever waive any such claim which may arise against Victory Church Int l., Inc., its employees or volunteers. I also understand that participants at Revolution Camp are liable for damage caused intentionally or maliciously. Damage caused by a participant will be billed directly to the participant responsible and their legal guardian. I understand that youth camp is a voluntary activity. Student must be willing to cooperate with the overall spirit and schedule of the camp. I grant my permission to Victory Church Int l., Inc. to use photographs (individual or group) and/or multimedia images and recording for the marketing and promotion of future camps and other ministry opportunities. I have reviewed the camp information sheet and gone over the camp policies and dress code with my child. This release specifically includes all claims and demands of whatever nature, actions and causes of actions, damages, costs, loss of services, expenses and compensation on account of or in any way growing out of personal injuries, illnesses, and/or property damage having already resulted or to result at any time in the future, whether or not contemplated at the present time or whether or not they arising following execution of this release. This release expresses a full and complete release of any liability, past or future, which may be claimed against Victory Church Int l., Inc., its trustees, officers, employees and volunteers. I authorize the adult in charge to consent to medical treatment for my child in the event that I or my assignee cannot be contacted. I understand that every effort will be made to contact me regarding any medical attention given to my child. I also understand that I will be held responsible for any medical expenses incurred and do hereby release Victory Church Int l., Inc. from any current and future liability. Parent Signature Date Camper Signature Date

6 Youth Camp Medication Form If your camper needs to bring any medication to camp, please complete this form within 24 hours prior to your camper s arrival at camp. All medications must be in the original containers. Place all medication containers in a plastic bag with this completed form detailing instructions for the use of each medication your child is to receive at camp. A medical attendant will receive medications at the nurse s table during camp check-in. Inhalers are the only meds that can be kept with the camper (please send two in case one is lost.) No medication can be administered unless listed on this from with Parent/Legal Guardian signature. Medical personnel in the infirmary must administer all camper medications. Camper Dorm # (assigned at camp) Church/City Parent Day Phone Parent Mobile Parent Evening Phone Name of Medication Dosage Time to be given Signature & Time Given (Nurse Use Only) Comments/Instructions: Medications will be given as directed on prescription containers. Explain any differences in instructions. Parent/Guardian I,, Parent/Legal Guardian of (Campers Name) authorize the camp medical personnel to administer the medications listed above. I authorize the Camp Executive Staff to consent to medical treatment when either my assignee or I cannot be contacted. I understand that every effort will be made to contact me before such action. Parent/Guardian Signature Date (24 hours prior to camp)