July 12-15, Return to: Delta Pride c/o A-State Wesley P.O. Box 2775 State University, AR 72467

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1 July 12-15, 2017 Return to: Delta Pride c/o A-State Wesley P.O. Box 2775 State University, AR Important Numbers: Sam Meadors, Wesley Director Samantha Black, DP Director Erin Gately, DP Asst. Director

2 Delta Pride 2016 Registration Form Name: Gender: M/F Date of Birth: / / Address: City: State: Zip Code: Grade Fall 17 Camper Cell: ( ) Adult t- shirt size: S M L XL 2XL 3XL Physical Limitations: Food Allergies: Medication(s) and when to take them: Preferred Roommate: Home Church: Parent(s)/Guardian(s): Phone: ( ) Emergency Contact: Phone: ( ) Relation: May we use pictures including you for DP publicity purposes? Yes / No

3 Workshops Every camper will attend three different workshops while at camp, one in the morning, one in the afternoon, and one in the evening. Please number your top choice (1-4) for all three workshop sessions, with one being your first choice. There is a list of workshop descriptions included to help you decide. Please only chose one session of Arts & Crafts. Morning Workshops: Outside Sports Arts & Crafts Dance Photo Journalism Afternoon Workshops Team Building Missions Theater Arts & Crafts Evening Workshops Outside Games Choir/Band What instrument? Cooking Handiwork Delta Pride is a God- centered camp, and anything that detracts from that will not be tolerated. Use of tobacco, alcohol, abusive language, weapons, matches, lighters, fireworks, illegal drugs or things forbidden by A- State policies are not allowed. Questionable behavior and apparel will not be tolerated. We reserve the right to send any camper home who violates these standards at your expense. Full camp rules are available at pride. Please sign and return ALL enclosed release forms with this registration form. By signing below, I understand and agree to the standards I am to uphold while at Delta Pride. Camper Signature: Date: By signing below, I agree to let my child attend Delta Pride 2017 in Jonesboro, Arkansas, and I understand the expectations all campers are held to. Parent/Guardian Signature: Date:

4 Delta Pride Rules and Release Form 2017 Camper s Name: Parent/Guardian s Name (Printed): Parent/Guardian s Insurance Plan & Number: Home Phone Father s Work Phone Mother s Work Phone Other Emergency # Father s Cell Phone Mother s Cell Phone I hereby give my permission for (child s name) to participate in Delta Pride activities. I give permission to authorize Delta Pride representatives to act in my absence, to authorize members of the medical profession, and any hospital to treat injuries incurred in activities sponsored by the A- State Wesley Foundation or Delta Pride. I shall assume all medical payments and recognize the Wesley Foundation medical insurance plan is considered to be supplemental in coverage. Further, I give my permission for to take the previously named medication(s) as ordered. I certify that one dose of the above medication(s) has been given and there was no adverse reaction from it. I understand that it is my responsibility to furnish this medication. I also understand that the designated Camp Nurse at Delta Pride who administers this medication to my child in accordance with written instructions from the prescribing health care provider and/or parent guardian shall not be liable for damages as a result of an adverse drug reaction suffered by the camper or because of a mislabeled or altered product. I understand that if my child shares his or her medication(s) with any other person while at camp, he or she will be sent home without refund at my cost. I certify by my signature below that the information on this form is correct and complete. I understand that there are inherent risks involved in any ministry or camping event, and I hereby release the camp, its directors, employees, and volunteer staff from any and all liability for any injury, loss, or damage to person or property that may occur during the course of my child s involvement. I am responsible for damages incurred by my child and realize I will be billed for them as necessary. Should my child need to return home due to medical reasons, disciplinary action, or otherwise, I will assume all transportation responsibilities. I permit my child to be transported in privately owned vehicles to and from approved, off- camp activities. I permit my child to participate in all prescribed camp activities, except noted by me. I permit the use of photographs and/or videos including my child to be used for camp publicity. Parent/Guardian Signature: Date: Parent/Guardian Name (Printed): Phone:

5 Authorization to Participate in Camp Activities and Request for Administration of All Medications Current Medications All medications (prescriptions and non- prescriptions) brought by campers must be in their original container and be turned in to the nurse upon arrival to camp. Campers may not keep even aspirin in their belongings. The Wesley Foundation and Delta Pride medication policy complies with state regulations. This form must be notarized and signed by a parent/guardian. This form must be completed and returned before any medication can be administered at camp. The medication must be in the original container and appropriately labeled. Self- administered medication DOES NOT included controlled substances such as Ritalin, Adderall, Concerto, etc. OR over- the- counter medications. Camper s Name: Current Infections Diseases: Allergies and Reactions: Physical and Behavior Reactions: Self- Administered Medication: Dosage: Frequency: Date Medication Started: Purpose: Side Effects: Prescription Medication: Dosage: Frequency: Date Medication Started: Purpose: Side Effects: Please list additional medications on a separate sheet. Other pertinent information or conditions that emergency personnel need to know: Parent/Guardian Signature: Date: Insurance is not required, but please attach a copy of your insurance card if available.

6 Delta Pride 2017 Workshop Explanations Morning: Outside Sports Games are games, but sports are sports. Bring out your inner competitor as you play flag football, kickball, ultimate Frisbee, soccer and other outside sports. Dance Practice the basics of dance while you learn choreographed dance routines. Show off your skills or just have fun on the dance floor! Arts and Crafts Campers will make a variety of arts and crafts projects that they will get to take home at the end of camp. Photojournalism Capture the Delta Pride experience through photographs and stories. Campers should try to provide their own camera if they wish to work as a photographer. Extra cameras will be limited. Afternoon: Team Building Learn to grow your leadership and team building skills with this fun, hands- on workshop. Counselors and campers will work through teamwork activities, games, group discussions, and more. Theater Campers will have fun with improv games, acting prompts, skits, charades, drama, and more. Missions Learn about different types of mission work opportunities, including trips, community service, and volunteer work available to those who want to serve the Lord. Campers will get to help with small, on- campus mission projects for the Wesley. Arts and Crafts Campers will make a variety of arts and crafts projects that they will get to take home at the end of camp. Evening: Outside Games Outside fun like water games, relay races, red rover, tag, oversized board games, etc. Choir and Band Learn songs to perform at closing ceremony with the camp band. Instrumentalist must bring your own instruments. Handiwork Learn basic tool skills and help construct projects. Projects will teach campers how to measure, cut, and assemble with lumber. Cooking Campers will learn how to cook fun and easy meals. There will also be cooking games like Iron Chef and Chopped. Limit 8-10 campers.

7 Don t Forget! Registration post- marked deadline is June 9, The late fee is $25. You are NOT guaranteed the workshops you sign up for, so get your registration in early! Bring a bit of extra money for pizza night! Show off your skills in the Talent/No Talent Show. Bring any items needed for your talent. Packing list, dress code, and other important camp information can be found online at pride Inappropriate cell phone use will result in a call to parents and loss of cell phone privilege for the remainder of camp. Cell phones will be safely stored until the end of camp.