STUDENT APPLICATION AYM SUMMER CAMP 2018

Transcription

1 STUDENT APPLICATION AYM SUMMER CAMP 2018

2 Important Camp Information Please read carefully! As set forth by the Executive Presbytery of the Appalachian District Council of the Assemblies of God Registration Fees $195 Regular Registration (Includes $85 non-refundable, transferable deposit with form. Balance due upon arrival.) $175 Early Registration (Same conditions for Regular Registration. Deadlines: JR/SR - June 4, Kids - July 9) Family Plan (applies to immediate family only & must meet Early Registration deadlines): First 2 campers pay full price and each additional student cost will be $145. Additional $15 late fee for On-site Registration (There is no guarantee of space available for any on-site registrations!) Refunds & Transfers 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 Mirst day of camp. Refunds must be requested via appydyd@suddenlinkmail.com. Refunds will be issued at the end of the camping season minus the non-refundable deposit of $85. We cannot refund monies for partial attendance to a week of camp. No refunds will be given for expelled students. All transfer of funds from one student to another must be done in advance and not on-site. No transfer of funds will be allowed from one camp year to the next. Registration Procedures 1) Complete the registration and health history form. 2) Secure ALL required signatures (camper, parent/guardian, & pastor). Failure to complete this will delay the registration process which could jeopardize acceptance to camp. 3) Send the completed registration form and non-refundable fee of $85 (made payable to AYM) to SUMMER CAMP, P.O. Box 310, GHENT, WV, NO PHONE, FAX OR APPLICATIONS WILL BE ACCEPTED. (*Note: Registration is on a Qirst come/qirst serve basis. On-site, non-registered individuals cannot be guaranteed a spot until all pre-registered and waiting list campers have been accounted for.) 4) NEW: It is imperative to have all forms in the hands of AYM in a timely manner. The late fee will not be waived by last minute phone calls, texting, ing, calling, and/or faxing of names and applications. An original signed application must be on property for each student from the start of camp for liability coverage. Camp Locations Jr./Sr. High Camp: Church of God State Campground - Roanoke, VA (8018 Angel Lane, Roanoke, VA 24019). Take I-81 towards Roanoke to Exit 146 (Hollins). If you are coming from the south turn left and from the north turn right off the exit ramp. At the fork in the road, turn left onto Angel Lane. The COG ofqice and campground will appear shortly on the right. Kids Camp: Camp Maranatha Dublin, VA (5900 Oak Grove Place, Dublin, VA 24084). Turn onto Route 100 towards Dublin from Route 460, Route 11, or I-81. Merge onto US-11 N/Broad St. and turn left at Oak Grove Pl. The campground will appear shortly on the right. Arrival & Departure Registration and room assignments begin at 1 PM on Monday. Room check-in is from 1-3 PM. No campers are to be on the grounds before this time. AYM will not be responsible for any campers before 1 pm Monday of camp. The Qirst meal will be dinner at 5:30 pm for campers & staff only. Camp concludes at 11 AM on Friday following the morning chapel service. All campers are to be off the grounds by NOON. AYM will not be responsible for campers after this time. Breakfast Friday morning will be the Qinal meal served.

3 What to Bring Bible Spending money Clothes, shoes, and swim suit for afternoon recreation Towels & beach towel Personal articles Appropriate attire for 4 evening services Soap/Shampoo Light sweater/jacket Pillow, sleeping bag & sheets for twin size bed Sunblock Optional Items: umbrella, camera Mark ALL personal items. AYM will NOT be responsible for possessions lost or stolen during camp. Leave valuables at home! For spending money, snack shack food, t-shirts, and other camp store items will be sold. It is highly recommended that campers have spending money ($25 or more). What NOT to Bring Cell phones, ipods, mp3 players, computers, video games, hoverboards, water guns or balloons, eireworks, nonprescription drugs, immodest or questionable clothing, snacks, weapons of any kind, alcoholic beverages, and tobacco products. (These items will be conqiscated if found and retained in an appropriate way) We reserve the right to inspect housing areas if there is any reasonable suspicion. Lack of cooperation, unnecessary roughness, disregard for camp rules, or damage to camp property will result in automatic expulsion from camp. Parents will be responsible for damage expenses and camper s transportation home. Clothing Policy Clothing must cover the shoulders, back, sides, and navel at all times. No spaghetti strap shirts or halter-tops will be allowed at any time. Sleeveless shirts will be allowed as long as they cover the shoulders during the day, but not during evening service. No low cut tops or dresses, hip hugger pants, or leggings will be allowed. Shorts must be of modest length. Clothing with obscene or lewd graphics or sayings will not be allowed, as well as anything promoting alcohol, tobacco, or illegal substance use. Proper attire for the evening services will be jeans, dress pants, capri pants, dresses, skirts below the knee, and modest shirts and shorts. Hats or visors may not be worn during evening services. Pool attire: Swimwear must be modest. A T-shirt will be required over immodest suits. Shirt, shorts, and shoes must be worn to and from the pool area. All inappropriate clothing will be subject to einal approval of the DYD. Camp Health Policy Due to very close living conditions, major disruptions occur when there is a health problem. Students with contagious health problems (i.e. impetigo, lice, etc.) WILL BE SENT HOME. It is recommended that these situations be monitored before leaving for camp. All camps will have complete checks before registration takes place. Please help us avoid embarrassing situations of having to either not admit or send a camper home. The AYM lice check form MUST be Lilled out and brought to registration the day of camp by your leader. A lice check must be performed on all potential campers the day of camp arrival. They can not be sent with the camp application in advance. In the event of an injury or illness that requires the attention of an emergency room or physician, parents will be notimied as soon as possible. Housing Policy ALL students will be housed before arriving on the campgrounds on a Mirst come Mirst serve basis. Add-ons cannot be guaranteed housing with their group. We will do our best to accommodate housing, but NO GUARANTEES!

4 NEW INFO: Please Read! Visitor Policy & Worker Screening Our district is aware about the need to protect minors even in the atmosphere of the church world. We must recognize that abuse could happen even in summer camps and we must take every precaution necessary to reduce the likelihood of it happening. Therefore, every camp staff member must take the Child/Youth/At Risk Abuse Awareness (aka Reducing the Risk ) training prior to their particular week of camp(s), and have a background check on file with our district office. *Background checks must be obtained through your local church affiliation, and must be renewed every three years. During camp, parents are asked to refrain from visiting and calling children. Experiences indicate that these allowances, as well as children asking to call home, often promote homesickness. In case of an emergency at home, call Adam Pelfrey, the District Youth Director, at In September 2014, the District Presbytery, in conjunction with Appalachian District Council and YCE Department moved to close the camp to outside visitors. We want to take every precaution necessary to insure the safety of our students. Visitors are not permitted on the property at any time during the week of camp and will be asked to leave the grounds. For more applications visit appyouth.com

5 2018 Summer Camp Application SELECT ONE CAMP & PLEASE PRINT CLEARLY! Jr/Sr High Camp 6/25-6/29 Ages Early Registration Deadline: June 4, 2018 REGISTRATION FEES (Check one that applies Deposit fee is due upon registration, Make checks payable to AYM ) $175 Early Registration $195 Regular Registration $145 Family Plan (Check this ONLY if student is the third camper or beyond in their immediate family. Please list the family members who are paying as the 1 st and 2 nd family members: and.) Kids Camp 7/23-7/27 Ages 7-11 Early Registration Deadline: July 9, 2017 Mandatory Deposit $85 $ Camp T-shirt $12 $ (Nonrefundable, transferrable) (Circle a size) Youth Sizes: YS, YM, YL Adult Sizes: S, M, L, XL,2XL,3XL TOTAL ENCLOSED $ OFFICE USE: Camper Information Last Name: First Name: Birth Gender (M/F): Age: Birth date (MM/DD/YY): Upcoming School: Upcoming Grade level: Home Address: City: State: Zip: Home Phone Number: Parent/Guardian Name: Emergency Contact: Address: Parent/Guardian Work/Cell Phone Number: Emergency Contact Phone Number: Church Name: Church City: Church State: 1st Desired Roommate: 2nd Desired Roommate:

6 Medical Information Physician s Name: Insurance Carrier: Physician s Phone: Insurance Carrier Phone: Policy Number: Group Number: Special Medications: Allergies: Type of Reaction(s): Treatment Given: Physical Handicaps, Disorders, or Diseases: Restricted Activities: ***The Appalachian District of the Assemblies of God provides SECONDARY HEALTH INSURANCE for all campers. Please check the communicable diseases this camper has had: Measles Polio Mumps Chicken Pox Scarlet Fever Whooping Cough Other: Please indicate the year this camper received the following immunizations: Diphtheria Whooping Cough Polio Tetanus Please check if camper has any of the following: Appendicitis Heart Trouble Ear Trouble Asthma Hernia Skin Trouble Allergies Lung Trouble HIV/AIDS Other: ***On a separate piece of paper, please explain any checked items AND list any medications (name/reason/ instructions) camper is taking. Please check if camper has problems with any of the following: Heart Trouble High Blood Pressure Skin Trouble Diabetes Seizures Migraine Headaches Bedwetting Ear Trouble Nosebleeds Headaches Kidneys Fainting Sinus Back problems Stings (allergic) Asthma (must have inhaler) If necessary, OTC medications may be given for mild complaints (i.e. headaches, stomach aches, etc.). Please indicate which medications are preferred: Tylenol Ibuprofen Tums Pepto-Bismol Other:

7 All medications brought to camp should be clearly labeled in the original container with camper s name, prescribing physician, prescription number, date prescribed, medication, and directions for use. All medications are kept in a secure location and dispensed by the camp nursing staff. A picture will be taken of campers for identieication purposes and they must know their birth date for medical administration. Campers will be taken to a local immediate care clinic or hospital emergency clinic for treatment when sick or injured. Please DO NOT send your child to camp if they have a fever or anything contagious including skin rashes, fungus, lice, etc. If a child misses camp due to sickness and has paid in advance, there is a NO refund policy. Authorization and Signatures I have read the attached information, and I will abide by ALL camp rules. I understand that violation of these guidelines may result in my dismissal from camp. Camper Signature I have read the attached information in regards to my child s attendance at summer camp. I understand that although campers are under careful supervision, accidents may happen. I m willing to assume that risk. I give consent for my child to participate in any camp activities, on and off campus. This medical form is correct, as far as I know, and the person herein described has permission to engage in all prescribed activities aside from those noted. IN CASE OF EMERGENCY, I hereby give my consent, in the event that all reasonable attempts to contact me have been unsuccessful, for the administration of any treatment deemed necessary by the appropriate licensed physician, dentist, or emergency personnel. By my signature, I release the Appalachian District Council of the Assemblies of God and its officers from any liability in case of injury or harm to my child, which is not the result of gross negligence by a camp staff member. I also acknowledge I am personally responsible for any damage to camp property or facilities caused by my student. I authorize the Appalachian District Council to use this child s image in photographs or video in any of its publications or other media. Parent/Guardian Signature Date I hereby endorse that the camp applicant is in good standing with the Assemblies of God church I pastor. Pastor Signature INCOMPLETE APPLICATIONS WILL BE RETURNED AND MUST BE RESUBMITTED BEFORE ACCEPTANCE.