2019 Breakaway Kids Camper Application

Transcription

1 2019 Breakaway Kids Camper Application

2 Greeting Kids Camp Coordinator! We are so excited you have chosen to spend your summer with us here at Lake Williamson. Please fill out the Camp Coordinator Form on the Kids Camp page of our website right away to let us who you are. This will enable us to provide information and reports accurately to you. We will send out an notification to let you know each time the Camper Reports are available. These s will contain a link to a Dropbox folder where you will download your church s Camper Reports as they are made ready, giving you access at your convenience. More information and detailed instructions will be included in the s as you begin to receive them. During the registration process for Counselors and Support Staff there will be a prompt for volunteers to send Personal & Pastoral Reference Forms directly to their references. New this year, volunteers are required to submit their photo for their lanyard at the end of their camp test. There is a simple link to follow where you will submit your photo. Please advise your volunteers that this is mandatory and will help to make registration day at camp much more seamless. Payments will still need to be made by check from your church. We know this takes extra help from you, but it is the best way to ensure camp remains at as low of cost as possible. There is a Financial Breakdown Sheet available for download on the Kids Camp Downloadable Forms Page that will need to be sent into the ISM office with each check. For us to be able to assign Color Teams in a timely fashion, Group Housing Forms need to be in our hands no later than one week before the start of your chosen week of camp. Online Registration closes 10 days before each week of camp. A report will be sent out the following day, so you will know if anyone has been added to your group. You have the option to mail or us your housing forms. Color Teams will be sent to you no sooner than the week before camp. Do not forget to bring the completed Lice Check Form with you to Registration Check-In. No group or individual will be allowed to enter camp without this form being completed prior to arrival. Coupon Codes: (These are only available to qualifying individuals. Please remember that RR and Mpact discounts are only available to churches who are chartered for the 2019 season.) Credentialed AG Ministers Child ($30/Child): PK2019MK Royal Rangers Chartered Member ($10/Child): CH2019RR Mpact Girls Chartered Member ($10/Child): CH2019MP We are excited to announce we will be launching a YouTube Channel complete with Instructional Videos for what to expect at Breakaway Camp. Examples of what these videos will include are First Time Counselor Information, How to get a Crown Room, A Tour of our Campgrounds and so much more! Follow us on social media and watch our website for these videos to drop! Our goal is to give you as much information as possible to help you and your team feel the most prepared when you step foot onto our campgrounds Monday morning. We can t wait to see what God is going to do with this 2019 Breakaway Camp Season! As always, if you have any questions or need help in any way, please us at ilsmonline@idcag.org or give us a call at The ISM Team

3 Greetings Breakaway Parent/Guardian! We are so excited that you have chosen to send your student to our camp this summer! To register, go to our Illinois Student Ministries website click the appropriate Camp Page link (Kids or Teen), then click the button that says To Register for Camp Click Here to register your student(s). Returning users: Log in with the same username and password you created last year. New users: You will be required to create a username and password. Coming Soon: If you will need assistance with the registration process, we will soon have an online video tutorial available to aid in the process. Watch for this to drop on social media (@ilsmonline) and/or our website at ilsmonline.org. When entering Contact Information, regulation says that one must give two numbers. If you only have one phone number, you may enter the same phone number in twice. It will ask for Guardian 1, Guardian 2 & an Emergency Contact; ONLY Guardian 1 and an Emergency Contact are required. The Medication Registration Sheet is part of the online process. You will enter all prescription and OTC medications for your child in this section. Payment is NOT available online. You should funnel payment through your church. If you are an individual registration without a church, please mail ISM a check directly. A High Ropes course is available for those in 3-12 grade. Visit the ISM website for more info on what High Ropes is. Visit our website for more tips/useful info. Click Additional Camp Info on either the Kids Camp or Teen Camp pages. Campwise has Technical support available to you for any problem or issue you have while registering your student(s) you can click Contact Us to find their number: Please contact your church s Camp Coordinator for more information or the ISM office at ilsmonline@idcag.org or Thank you! -The ISM Team **Please continue on reverse side to read our 2019 Camp Instructions and Disclosures**

4 2019 Breakaway Camp Disclosures & Code of Conduct REGISTRATION: No phone registrations, nor incomplete registrations will be accepted. Walk-ins may be accepted based on our capacity and counselor to camper ratio. All monies must be received by registration check-in on Monday in order for a student to attend. Students or groups registering by the early registration deadline must pay the correct deposit amount to be eligible for the early registration pricing. T-SHIRTS: T-shirts are available for purchase for those who registered by (May 8 - Kids Camp/June 8 - Teen Camp) for $7 or $9 depending on size. Orders taken after (May 8-Kids//June 8-Teen) will be available on a first come, first serve basis. DEPOSITS: A student or group may register by making a $100 deposit per camper. (Deposit MUST include payment for any extras purchased: high ropes course & t-shirts). Registration must be PAID IN FULL on or before the first day of camp. No deposits will be accepted without the camper(s) applications. Payments should be made to your church and they will forward to us. If you are coming as an individual, please send all necessary contact information with your payment. REFUNDS: Due to programming costs, refunds for students who are unable to attend a full week of camp must be requested a minimum of SEVEN DAYS prior to the first day of camp. Refunds must be requested via an official Refund Request Form which can be obtained through our offices. Refunds will be issued at the end of the camping season minus a $50 fee per student. We cannot refund monies for partial attendance to a week of camp. No refunds will be given for expelled students. INDIVIDUAL HOUSING: ALL students will be housed before arriving on the campgrounds. If a student is coming as an individual, but would like to be housed with a group, we will do our best to accommodate requests if it is made by MAY 15 (for Kids Camp) or June 15 (for Teen Camp), however, NO GUARANTEES! GROUP HOUSING: All students will be housed before arriving on the campgrounds. A church coordinator is responsible for getting us this information no later than MAY 15 (for Kids Camp) or June 15 (for Teen Camp). Students grades 1-2 are housed 8 campers/2 counselors and students grades 3-12 are housed 9 campers/1 counselor. CAMP SCHEDULE: Registration check-in begins the Monday at 10AM of each week of camp. Student orientation begins at 2PM. Please plan to bring a sack lunch or money to eat at the Lake Williamson Dining Hall ($4.00 per person) for Monday lunch. The first camp meal served will begin at 5PM on Monday. Camp checkout is 11AM on Friday. NON-CAMPER POLICY: ISM summer camps are CLOSED camps. All camp activities including evening services are open only to registered campers and staff. Any child, student, or adult violating this policy will be asked to leave the grounds. LOST AND FOUND: Any lost and found items left on grounds after the conclusion of camp will be held for two weeks. If not claimed during that time period, items will be donated. Claimed items will be shipped back to their owners at their owner s expense. CAMP PROPERTY DAMAGE: Charges for items broken/damaged during camp will be billed to all parties/individuals involved. INSURANCE: Secondary medical coverage for accidental injuries is with Brotherhood Mutual Insurance. WHAT TO BRING: Sleeping bag or twin sheets, blanket, pillow, towel, recreational clothes, & gym shoes, toiletries, modest swimwear (no bikinis), Bible, spending money is needed for BGMC/STL offering, snacks and camp store. Please clearly label all items. Campers are responsible for personal belongings. ISM is not responsible for lost/stolen items. WHAT NOT TO BRING: No weapons, tobacco, electronic devices, laptops, video games, SILLY STRING, water guns, water balloons, sidewalk paint, tape, or spray paint products (including colored hair spray) will be permitted. DRESS CODE: MODESTY. No revealing clothing will be permitted. This includes: short dresses, skirts, or shorts (4 inch inseam), leggings, plunging necklines, spaghetti straps, cut off t-shirts (showing sport bras) or cut off shorts, bikinis, and speedos. EXPECTATIONS: Regulations are given as guidelines for every camper to follow. This code of conduct has been established for your students protection and the benefit of every person present. The lack of cooperation, unnecessary roughness, lack of respect for property, or an unwholesome attitude on the part of any camper will result in expulsion from camp. The expense of transporting the expelled camper(s) home from camp is the responsibility of the parents/guardians

5 il kids summer camp application form please complete application in its entirety before returning to your church group. incomplete applications will incur a delay in processing. step 1: Which week will you be attending? breakaway kids grades 1-2 week 1 june breakaway kids grades 3-6 week 1 june breakaway kids grades 1-2 week 2 june breakaway kids grades 3-6 week 2 june step 2: Camper information FIRST NAME LAST NAME MI D.O.B. (MM, DD, YY) AGE SEX GRADE (Completed) MAILING ADDRESS CITY STATE ZIP+4 AREA CODE + PHONE NUMBER PARENT S ADDRESS -- NAME OF CHURCH ATTENDING WITH CHURCH CITY YOUTH LEADER NAME step 3: please talk to your church regarding camp payment early bird registration regular registration A B C postmarked by May 1 postmarked by May 8 early bird registration YS YM YL S M L XL XXL XXXL (Please circle size & place on group t-shirt form) high ropes (optional) *must pre-register (3-6 only) I am the CHILD of a credentialed AG minister $209 $7 $9 $20 $-30 **Please note: Deposits must include payment for extras (high ropes & t-shirts). If they are not paid for, students may purchase them when they arrive at camp. regular registration YS YM YL S M L XL XXL XXXL (Please circle size & place on group t-shirt form) high ropes (optional) *must pre-register (3-6 only) I am the CHILD of a credentialed AG minister $235 $7 $9 $20 $-30 **Please note: Deposits must include payment for extras (high ropes & t-shirts). If they are not paid for, students may purchase them when they arrive at camp. late registration postmarked after May 8 late registration I am the CHILD of a credentialed AG minister $260 $-30 All late registrants will have the opportunity to purchase a t-shirt at the camp store after camp begins. TOTAL CAMP AMT: TOTAL ENCLOSED: TOTAL CAMP AMT: TOTAL ENCLOSED: TOTAL CAMP AMT: TOTAL ENCLOSED:

6 step 4: please complete with parent or guardian information CAMPER NAME PARENT/GUARDIAN NAME(S) PARENT/GUARDIAN PHONE NO. PARENT/GUARDIAN ADDRESS ALTERNATE EMERGENCY CONTACT PERSON EMERGENCY CONTACT PHONE NO. EMERGENCY CONTACT PERSON S RELATIONSHIP TO CAMPER Early departure Policy: Only an authorized person designated on the registration form may remove a camper from camp early. Please list authorized person(s). Is there anyone to whom we should NOT release your child? Please list complete name (s). step 5: Please complete with health care information - must be completed by parent or guardian on a separate piece of paper please explain any checked items AND list any medications (name/reason/ instructions) camper is taking. All medications, prescriptions, and over-the-counter drugs must be brought in the original container to the nurse during registration. PLEASE DO NOT SEND EXPIRED MEDS! INSURANCE CARRIER COVERAGE START INSURANCE CO PHONE NUMBER INSURED S NAME (FIRST) (LAST) INSURANCE / POLICY / OR GROUP NUMBER Does the camper have allergies? Yes No If yes, please explain: Please list the year camper received the following immunizations: Diptheria Whooping Cough Polio Tetanus Toxoid What communicable diseases has this camper had? Measles Polio Mumps Chicken Pox Scarlet Fever Whooping Cough Other Does camper have: Heart Trouble Ear Trouble Asthma Hernia Pregnancy HIV/AIDS Other Is there any information we should have regarding the welfare of this camper (handicaps, restrictions, etc.?) step 6: Please read and sign no camper can be accepted without a parent/guardian signature I do hereby state that I have legal custody of this child, a minor, who resides with me. While this minor is a registered camper at any Illinois Assemblies of God summer camp, I hereby authorize any director, counselor, nurse, dean, lifeguard, or other responsible person of said Camp to consent to any x-ray, examination, anesthetic, medical or surgical treatment, and hospital care, to be rendered to this minor under the general or special supervision and on the advice of any physician or surgeon licensed to practice in the United States, when such medical or surgical treatment is necessary. I also give permission for my child to receive over-the-counter medication from the camp nurse if necessary. We give full permission to Illinois Assemblies of God summer camps to reproduce any photograph and/or video image of me/my student for promotional usage without obligation to me/my student. We have read the rules and agree to abide by them and do hereby give permission to participate in all camp activities. Parent/Guardian Signature (Required) Date

7 Swim Competency Test Waiver Form Swim Competency Information: Illinois Student Ministries and Lake Williamson Christian Center requires all participants who partake in water (indoor pool, outdoor pool and lakeside) activities to show competency and confidence of swimming skills. Activities for participants who show this competency include, but are not limited to, swimming in the deep end of pools (indoor and outdoor) and being allowed to utilize water inflatables, water trampoline and other water games/activities in the deeper parts of the lake.* Students wishing to participate in said activities will be required to test unless this form is completed. Lake Williamson s Swim Competency Test consists of the following: 1. Swimmer must jump (feet first) into the deep end of the pool and fully submerge themselves. 2. Swimmer must be able to collect themselves after resurfacing and swim unassisted from the deep end of the pool to the shallow end of the pool. All campers who prove their Swim Competency or waive the Swim Competency Test will be given a bracelet and allowed to participate in above mentioned deep water activities. Any camper who does not waive the Swim Competency Test and does not prove to their Swim Competency will be restricted to designated shallow areas of the pools and lake. Participant Information: Name of Participant being Waived: Date of Birth: M F Grade Level Completed: Name of Parent/Guardians: Participation Agreement: By signing below, I confirm that I am the parent/guardian of the child(ren) listed. I also confirm that my child(ren) has the swimming skills necessary to safely participate in swimming activities including but not limited to those listed above and may forego the Swim Competency Test. I acknowledge that waiving the Swim Competency Test involves risk to the participant (and to the participant s parents or guardians if the participant is a minor), and may result in various types of injury included, but not limited to, the following: sickness, bodily injury, death, emotional injury, personal injury, property damage, and financial damage. In consideration for the opportunity to waive the Swim Competency Test as described above, the parent/guardian of participant acknowledges and accepts the risks of injury associated with financial responsibility for any injury or other loss sustained as a result of waiving the Swim Competency Test during water activities or during transportation to and from the activities, as well as for any medical treatment rendered to the participant that is authorized by Illinois Student Ministries and Lake Williamson or their agents, employees, volunteers or any other representatives. Further, the parent/guardian releases and promises to indemnify, defend and hold harmless Illinois Student Ministries, Lake Williamson Christian Center, Illinois District Council Assembly of God, it s directors, associates and affiliates for any injury arising directly or indirectly out participation in water activities or transportation to and from the activity, whether such injury arises out of the negligence of the activity sponsor, the participant or otherwise. If a dispute over this agreement or any claim for damages arises, the parent/guardian agrees to resolve the matter through a mutually acceptable alternative dispute resolution process. If the parent/guardian and the activity sponsor cannot agree upon such a process, the dispute will be submitted to a three-member arbitration panel for resolution in accordance with the rules of the American Arbitrations Association. Signature: Date: Parent/Guardian Printed Name: *Regardless of swim level, all participants (counselors included) are required to wear a Personal Floatation Device (PFD) while participating in any waterfront activity. Also, Certified Lifeguards** will be on duty at all water locations during all times while campers are present. **Lake Williamson s Certified Lifeguards maintain the right to, at any point, instruct a participant to complete a Swim Competency Test (regardless of waiver status) if they feel the participant does not have the necessary swimming abilities to safely participate in water activities. On-duty Lifeguard discretion supersedes this waiver.

8 Breakaway Kids Camp Breakdown Sheet Please fill out this form COMPLETELY and send it along with ALL payments being made Make checks payable to: ISM, PO Box 620, Carlinville, IL Step 1 CONTACT INFORMATION (please print) Church City Camp Coordinator Church Name Camp Coordinator Phone # Church Phone # Camp Coordinator STEP 2 CHOOSE CAMP BREAKAWAY KIDS BREAKAWAY KIDS Week 1 June Week 2 June STEP 3 LIST PERSONS REFLECTED IN PAYMENT BEING SUBMITTED (Please make copies of this section as needed for additional students) Is this a camper, a counselor Name or support staff? Total Amount submitted today Is this a deposit, full payment or payment of remaining balance? Ex John Smith camper counselor sup. staff $35 deposit pymt in full remaining balance Ex Jenny Sky camper counselor sup. staff $99 deposit pymt in full remaining balance 1 camper counselor sup. staff deposit pymt in full remaining balance 2 camper counselor sup. staff deposit pymt in full remaining balance 3 camper counselor sup. staff deposit pymt in full remaining balance 4 camper counselor sup. staff deposit pymt in full remaining balance 5 camper counselor sup. staff deposit pymt in full remaining balance 6 camper counselor sup. staff deposit pymt in full remaining balance 7 camper counselor sup. staff deposit pymt in full remaining balance 8 camper counselor sup. staff deposit pymt in full remaining balance 9 camper counselor sup. staff deposit pymt in full remaining balance 10 camper counselor sup. staff deposit pymt in full remaining balance 11 camper counselor sup. staff deposit pymt in full remaining balance 12 camper counselor sup. staff deposit pymt in full remaining balance 13 camper counselor sup. staff deposit pymt in full remaining balance 14 camper counselor sup. staff deposit pymt in full remaining balance 15 camper counselor sup. staff deposit pymt in full remaining balance 16 camper counselor sup. staff deposit pymt in full remaining balance 17 camper counselor sup. staff deposit pymt in full remaining balance 18 camper counselor sup. staff deposit pymt in full remaining balance 19 camper counselor sup. staff deposit pymt in full remaining balance 20 camper counselor sup. staff deposit pymt in full remaining balance 21 camper counselor sup. staff deposit pymt in full remaining balance 22 camper counselor sup. staff deposit pymt in full remaining balance 23 camper counselor sup. staff deposit pymt in full remaining balance PLEASE TOTAL: CHECK# CHECK TOTAL $ **PLEASE MAKE SURE YOUR CHECK TOTAL MATCHES THIS TOTAL!** For office use only: Pstmk Dt: Processor Intials : _ Dt Processed:

9 Breakaway Kids Group Housing Form 1-2 Kids Breakaway Camp For Students Who Have Completed Grades 1 or 2 Postmark Deadline May 15, 2019 Please list how you would like your group to be roomed. Understand a counselor is not guaranteed until approved by the director. Some rooms hold up to 12 people; you may write in 2 extra spaces if need be, and we will contact you should there be a problem. Be sure to list any support staff or additional counselors (not already listed in your rooms) in the space provided. Please print: Check Week Attending: Church City BREAKAWAY KIDS BREAKAWAY KIDS Week 1 June Week 2 June Camp Coordinator Church Name Camp Coordinator Phone # Church Phone # Camp Coordinator Room #1 Room #2 Room #3 Room #4 (continued on reverse side) For office use only: Original Form Revised Form Dt Rec d:

10 Church City Church Name Room #5 Room #6 Room #7 Room #8 Males Support Staff Females Available Counselors Not Roomed Males Females

11 Breakaway Kids Group Housing Form 3-6 Kids Breakaway Camp For Students Who Have Completed Grades 3 thru 6 Postmark Deadline May 15, 2019 Please list how you would like your group to be roomed. Understand a counselor is not guaranteed until approved by the director. Some rooms hold up to 12 people; you may write in 2 extra spaces if need be, and we will contact you should there be a problem. Be sure to list any support staff or additional counselors (not already listed in your rooms) in the space provided. Please print: Check Week Attending: BREAKAWAY KIDS Week 1 June BREAKAWAY KIDS Week 2 June Church City Camp Coordinator Church Name Camp Coordinator Phone # Church Phone # Camp Coordinator Room #1 3 rd - 4 th Grade 5 th -6 th Grade Camper#9 Room #3 3 rd - 4 th Grade 5 th -6 th Grade Camper#9 Room #2 3 rd - 4 th Grade 5 th -6 th Grade Camper#9 Room #4 3 rd - 4 th Grade 5 th -6 th Grade Camper#9 (continued on reverse side) For office use only: Original Form Revised Form Dt Rec d:

12 Church City Church Name Room #5 3 rd - 4 th Grade 5 th -6 th Grade Camper#9 Room #7 3 rd - 4 th Grade 5 th -6 th Grade Camper#9 Room #6 3 rd - 4 th Grade 5 th -6 th Grade Camper#9 Room #8 3 rd - 4 th Grade 5 th -6 th Grade Camper#9 Males Support Staff Females Available Counselors Not Roomed Males Females

13 Church City BREAKAWAY KIDS CAMP LICE CHECK FORM Bring this form with you to camp Church Name Students must be checked for lice BEFORE arriving at camp for registration. Please do a lice check at your church before leaving for camp. If you suspect a child might have lice, be sure to check early enough so said child and his/her personal items can be treated before camp. Have a qualified person, (teacher, nurse, etc) give each child a thorough check and then add their names to the list below. Be sure to bring the list with you to Registration Check-In. Any camper needing to be checked for lice at the camp will be charged $10 to be paid by the church, separate from the registration fee. Camper Lice Free Camper Lice Free I have checked each of these children for lice and they are lice free. I understand that if children are brought to camp with lice, they may be sent home. Signature of Qualified person checking for lice

14 Packing for Kids Camp WHAT TO BRING Bible/ Notebook/ Pen Color Team supplies Bedding (Sheets (twin), sleeping bag, pillow, blanket) Sunscreen/ Bug Spray Towels & Wash Clothes Alarm Clock Modest swimwear- (1 piece or Tankini- no 2 pieces allowed) Casual clothing Money for BGMC/ STL offering Money for Cafe & ISM Store Tennis Shoes/ Flip Flops Toiletries (deodorant, shampoo, tooth brush & paste, etc...) Air Fresheners Snacks WHAT NOT TO BRING Spaghetti Straps or Strapless Shirts Short Shorts/ Short Skirts Bikini/ Speedos Cutoff shorts/shirts (no sports bras allowed to show) Spandex (shorts or shirts leggings allowed if covered with another article of clothing.) Water Guns No Paint, Silly String or Tape is allowed Water Balloons Campers are responsible for all personal belongings. Please clearly label all items. ISM is NOT responsible for lost or stolen items.