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 THIS FORM IN ANY WAY (please type or print) NAME Sex F / M (CIRCLE ONE) AGE DURING CAMP BIRTH DATE / / GRADED COMPLETED THIS YEAR MO DAY YR SCHOOL ATTENDS PARENT'S OR GUARDIANS' NAME DOES CAMPER LIVE WITH BOTH PARENTS? IF NOT, WITH WHOM RELATIONSHIP HOME ADDRESS CITY HOME PHONE( ) FATHER'S OCCUPATION BUSINESS PHONE( ) MOTHER'S OCCUPATION BUSINESS PHONE( ) IN CASE OF EMERGENCY AND IF PARENTS CAN'T BE REACHED, NOTIFY BUSINESS PHONE( ) HOME PHONE( ) WHAT IS THIS PERSON'S RELATIONSHIP? WHAT CHURCH DOES THE CAMPER ATTEND WHAT CHURCH IS CAMPER COMING WITH HAS THE CAMPER ACCEPTED JESUS CHRIST AS SAVIOR? YES NO (CIRCLE ONE) WHEN WHAT ACTIVITIES AT CHURCH IS THE CAMPER INVOLVED IN?
PARENT PLEASE CHECK THOSE STATEMENTS THAT APPLY TO YOUR CAMPER HAS BEEN TO CAMP BEFORE AFRAID OF THE DARK AFRAID OF WATER BED-WETTER TAKES COLD EASILY FEELINGS EASILY HURT SHOW SENSE OF INFERIORITY CRITICAL/FAULT FINDING SHY TRY TO DOMINEER SUNBURN EASILY EASILY DISCOURAGED PREFER A LARGE GROUP OF PLAYMATES PREFER A SMALL GROUP OF PLAYMATES SHOULD NOT USE UPPER BUNK WHAT DO YOU WANT YOUR CAMPER TO GET OUT OF CAMP? WHAT DOES YOUR CAMPER WANT TO GET OUT OF CAMP? LIST ANY SPORT OR ACTIVITY LIMITATIONS THAT YOUR CAMPER MAY HAVE: CAMPER HAS PERMISSION TO ENGAGE IN ALL CAMP ACTIVITIES EXCEPT: (List all prohibited activities) PLEASE SHARE ANY OTHER INFORMATION THAT WOULD AID YOUR CAMPER'S COUNSELOR IN KNOWING YOUR CAMPER BETTER: BE SURE TO READ THE CAMPER INFORMATION SHEET, GENERAL RULES AND REGULATIONS FOR CAMPS AND RETREATS PLEASE READ CAREFULLY AND SIGN PARENT'S AUTHORIZATION-I approve the application above and the conditions listed here and on the CAMP HEALTH FORM, and hereby certify that my child is of good moral character. My permission is hereby granted to use pictures of my child in camp advertising material. It is agreed that Pulaski Baptist Association, Inc., will not be held responsible for unforeseen accidents or illness of my child. I grant permission for my child to participate in every Camp sport and activity unless listed and discussed above. I recognize there is an element of risk in activities I or my child may participate in while staying at Pulaski Baptist Camp. I assume full responsibility for my child or self, for any accident or injury that may occur while staying at Pulaski Baptist Camp. I hereby release, indemnify, and hold harmless Pulaski Baptist Association, Inc., and/or Pulaski Baptist Association Camp Inc., its agents and employees, from and against any and all claims, liabilities, suits, actions, attorney's fees, and including without limitation any act, omission, or negligence of Pulaski Baptist Association, it's agents, employees, which may arise from or in any way be connected with my child's/my stay or participation in activities at Pulaski Baptist Camp. BOTH PARENTS/GUARDIANS SIGNATURE IS REQUIRED. SIGNED RELATIONSHIP DATE SIGNED RELATIONSHIP DATE
CAMPER HEALTH FORM ALL YOUTH TAKING MEDICATIONS MUST BRING A CURRENT PHOTO (This health history is accurate as far as I know) CAMPER'S NAME Date of last tetanus shot CAMPER HAS HAD: ear infections heart trouble measles chicken pox dietary restrictions (explain) surgery or serious health problems (please explain) CAMPER IS ALLERGIC TO: bee sting penicillin poison ivy poison oak sumac dust other (list and explain) Does your camper have asthma? YES NO (CIRCLE ONE) Does camper have any contagious diseases? YES NO (CIRCLE ONE) If so what? Name of Medication Dose in mg. Amount/# to be given Time to be given Complete at registration Total # of pills & initial of parent/staff I give the personnel of Pulaski Baptist Camp permission to administer the above medications as directed to my camper Name of Camper Signature of parent/guardian Date ** All medications must be brought in original bottle or container. All prescription medicines must have pharmacy label, including name of doctor, and must have current photo. ** All medications must be turned in to camp personnel. **All medications to include Tylenol, Ibuprofen, and vitamins will be kept by camp nurse in a locked, Secure area. The only medication that a camper will be allowed to keep in their possession is a Rescue/emergency inhaler for asthma. Campers who use inhalers are to be instructed not to share their inhaler with anyone else. **Sharing of medication by a camper will result in referral of the camper to the camp director. I give the Pulaski Baptist Camp nurse permission to administer the following over the counter medications as needed to my camper according to the manufacturer s directions. Please check all you wish to be given as needed. Signature of parent/guardian Date Tylenol Ibuprofen Orajel Caladryl Lotion Chloraseptic spray Halls Cough Drop Antibiotic ointment Sunburn spray/ Lotion with Lidocain In the event I cannot be reached in an emergency, I hereby give permission for the physician selected by the Camp Coordinator or Camp Administrator, to hospitalize, secure proper treatment for, and to order injection, anesthesia or surgery for my child, named above. I also will notify Pulaski Baptist Association if my camper has been exposed to any communicable diseases during the 3 weeks prior to camp attendance. BOTH PARENTS/GUARDIANS SIGNATURE IS REQUIRED. SIGNED RELATIONSHIP DATE SIGNED RELATIONSHIP DATE
CAMP T-SHIRT ORDER FORM T-SHIRTS SIZES CAN ONLY BE ORDERED BY June 22, 2017 Remember, turn in your completely filled out camp application to the Associational office by JUNE 22, 20176 Please check your size of T-shirt: ADULT SMALL ADULT MEDIUM ADULT LARGE ADULT X LARGE ADULT XX LARGE NAME OF CAMPER PERMISSION TO VIDEO THIS YEAR WE WILL BE PRODUCING A VIDEO OF OUR WEEK AT CAMP. THIS VIDEO WILL BE USED FOR CAMP PURPOSES ONLY. WE NEED THE PERMISSION OF THE PARENT/GUARDIAN IN ORDER TO TAKE PICTURES OF YOUR CHILD OR YOUTH. NO NAMES WILL BE USED IN THIS VIDEO. PULASKI BAPTIST ASSOCIATION HAS MY PERMISSIN TO VIDEO MY CHILD/YOUTH TO BE USED FOR CAMP PURPOSES/PROMOTION ONLY. PARENT/GUARDIAN
CAMP RULES AND REGULATIONS 1. All medications must be turned in to the nurse upon arriving at camp! This includes Aspirin, Tylenol and any other over the counter medications which you might take. 2. If you have trash, find a trash can. 3. No showing of affection. 4. You must attend all camp activities. 5. You must be in your cabin from lights out through morning rise and shine. 6. No late night cabin raids or cabin switching. 7. No radios, ipods/mp3 players, cell phones etc. allowed at camp 8. No intoxicating beverages, illegal drugs, smoking or chewing is allowed at any time. 9. Wear shoes when you leave your cabin. 10. Dress modestly at all times coaches have final say on all clothing 11. No jewelry of any kind is allowed in the pool area. 12. No two piece swimming suits. If your child takes medications please bring a current photo to be placed in bag with medications for the nurse.
REGISTRATION PLACE AND TIME Registration for campers will be in the Multi Purpose Building Foyer on the first day of camp from 1:00-2:00 p.m. THINGS TO BRING TO CAMP Try to pack light. There is very little space for each camper. A small suitcase that can slide under the bed works Best, like those that fit in an aircraft overhead bin. Bedding (twin bed) A sleeping bag is recommend. It is easier than making a bed in the morning. An option is bed linen for a twin bed (2 sheets and blanket). Don t forget your favorite pillow Personal Health Care Items: Soap Wash Cloths Towels (at least three are recommended shower, pool, spare) Shower Shoes (also good for going to pool) Toothbrush and Toothpaste (remind them to use them). Comb Deodorant (Consider this optional if they are not using it now). Shampoo Sunscreen (oil free) Bug Repellent Clothing (five days) Daily wear is normally shorts and T-shirts/blouses. It sometimes gets cool at night. At least one pair of long pants and a light jacket are good extra items. Maybe one long sleeve shirt if the camper gets cold easily. Save the good stuff for home. We plan to have fun. Something to sleep in. T-shirt and gym shorts are fine. Shorts (no short-shorts or gym/jogging shorts please) Shirts/blouses (Christian or sports logos only please). Jeans/pants (at least one pair it gets cool sometimes) Light Jacket (just in case) Underwear Socks (send a couple extra pairs). Swim Suit (No cut off shorts please and no bikini or other two piece or overly reveling swim suits please) Athletic Shoes (2 pairs recommended). For safety reasons, shower shoes are not allowed as daily foot wear in the camp area. Laundry Bag or garbage bag for dirty clothing. OTHER ITEMS: BIBLE. A Bible Cover is helpful. It allows the camper to store something to write with and the camp morning devotional guide. Money. There is no place to spend money at camp. We do take a Mission Offering once during the week as part of a mission lesson. It is recommended the offering be sealed in an envelope (No more than $10.00 please). If it is a check please make payable to Pulaski Baptist Association. We will let the kids decide what mission they will support with this offering. Disposable Camera. This is a good way to help camper record their week and remember their new friend. WHAT NOT TO BRING TO CAMP. Here are some things campers cannot bring: Cell Phones, Sun tan oil (harmful to pool) radios, hand held games, tape recorders, ipods, jewelry, valuable items, fireworks, drugs, alcohol, pornography, weapons and knives. Bringing candy and extra food items, it also discouraged. It attracts bugs and we have a free shack bar. If extra food shows up in the cabins, it is share by everyone. PLEASE NOTE: If anything is left at camp, please call the Pulaski Baptist Association Office (573-774-2926) to make arrangements for picking it up. Anything left at the Pulaski Association Office over 30 days will be disposed of.