KIDS CAMP RULES AND GUIDELINES PARENTS/GUARDIANS PLEASE READ 1. Please complete all forms and complete every question. Failure to do so may delay processing. 2. We are asking parents NOT to call children or children to call home unless there is an emergency. 3. Only medicine in the ORIGINAL container and labeled with the child's name will be accepted. 4. Please include one medication form per camper with all medications included on form. 5. Over the counter medications (Tylenol, Pepto-Bismol, etc...) are provided at the campground. Please do not send any unless it is unusual. 6. All medicine should be given to the sponsor and will be brought home by the sponsor. 7. No child will be allowed to leave the campground to visit relatives or friends. 8. Please do not visit the children at camp. This often causes homesickness for the camper. 9. Please do not send children to camp with fever or a communicable disease. 10. Please do not send a child with an ear infection or lice. (Lice checks should be done prior to camp) 11. Infections, scratches, abrasions, eye, ear and throat irritations should be reported with a note to the nurse. 12. If ear plugs are needed, please send them labeled with the child. 13. Please label envelope with name and amount of spending money for camp bank. (All money should be in 1 s or 5 s) 14. T-shirts are NOT included with the camp registration fee. Make sure that the t-shirt size is marked on the registration form. Extra camp t-shirts and kidappropriate merchandise will be available for purchase on first come basis in limited sizes. 15. Children may wear modest short outfits to all activities. No short shorts or abbreviated at tire (half shirts, midriff & hip huggers with stomachs showing.) No strapless or spaghetti tops. 16. Cover up t-shirts are required to be worn when going to the lake and/or the pool. 17. Label the luggage with name, address, phone and home church. 18. No food, ice chest, small refrigerators are allowed in the dorms.
ITEMS NEEDED AT CAMP Modest swimsuit Dirty Clothes bag (cloth / mesh not plastic) 4-8 sets of clothing Soap 4-8 sets of under clothes Deodorant 1 set of twin bedding Toothbrush and toothpaste 1 blanket 1 pillow Shampoo Clothespins 4-5 Towels Spending money 4-5 Washcloths T shirt cover-up (to wear from the lake to the pool) Hair brush/comb Bible and Journal DO NOT BRING TO CAMP Drugs Un-labeled medication Knives or firearms Tobacco Fireworks Pets Food or snacks (attracts ants in dorms) *The camp is not responsible for lost or stolen personal items. Individuals needing reasonable accommodation under ADA should contact the Camp Director prior to arriving for camp.
2018 KIDS CAMP CAMPER REGISTRATION WHICH CAMP WILL YOUR CHILD BE ATTENDING? KIDS CAMP #1 DATES: JULY 2-6 (Mon-Fri) KIDS CAMP #2 DATES: JULY 8-11 (Sun-Wed AM) KIDS CAMP #3 DATES: JULY 11-14(Wed PM-Sat) NAME: GENDER: AGE: DOB: / / _/ ADDRESS: CITY (ST) ZIP CHURCH: PASTOR: CH PHONE: ( ) COORDINATOR NAME: COORDINATOR EMAIL: @. CELL: MEDICAL HISTORY - CHECK IF CHILD HAS HAD ANY OF THE FOLLOWING CONDITIONS: DIABETIC HEART PROBLEMS MEDICATIONS YOUR CHILD WILL BE TAKING AT CAMP: ASTHMATIC HIGH BLOOD PRESSURE EPILEPTIC FAINTING, DIZZY SPELLS ALLERGIES MEDICAL CARE/SURGERY TUBES IN EARS I NSECT STING REACTION OVERHEAT EASILY PRE-EXISTING CONDITIONS NOTE: ALL MEDICATION MUST BE PRESCRIBED IN CAMPER'S NAME AND IN ITS ORIGINAL CONTAINER. YEAR OF MOST RECENT TETANUS SHOT : OTHER MEDICAL FACTS OR ALLERGIES WE SHOULD KNOW: EMERGENCY CONTACT (IF YOU CAN T BE REACHED) PHONE:( ) RELATIONSHIP TO CHILD PARENT/GUARDIAN NAME PHONE: HOME: ( ) WORK ( ) CELL ( ) ADDRESS E-mail: CITY STATE ZIP HEALTH INSURANCE INFORMATION Health Insurance coverage? yes no NAME OF COMPANY ADDRESS OF COMPANY POLICY NUMER CLAIMS PHONE # NAME OF PRIMARY PERSON (ADULT) ON POLICY
I give my permission for my child to participate in all camp-related activities. I give my consent for the camp nurse or other appointed authority to administer proper medication as needed. In the event I cannot be notified of necessary emergency surgery or other medical treatment for my child, I give my permission for the attending physician to treat my child in the manner he / she recommend. I release the Louisiana District Council Assemblies of God, Inc., Twin Lakes Campground and/or any of their agents from any and all liabilities in regard to any accident or injury as well as any treatment rendered I also give my permission for my child to be photographed and/or videoed as a participant in the camp activities, and for those photographs and/ or videos to be used in the best interest of the Louisiana District Council Assemblies of God. (signature required) Registration forms are due back to church coordinator by: Individuals needing reasonable accommodation under ADA should contact the Camp Director prior to arriving for camp.
2018 Kids Camp Adult Sponsor Application Please indicate the camp you desire to attend. T-shirt (Please add $10 to reg. cost) KIDS CAMP #1 JULY 2-6 adult small adult X-Large KIDS CAMP #2 JULY 8-11 adult medium 2X 3X KIDS CAMP #3 JULY 11-14 CHURCH CITY NAME: DOB: / / M / F MARRIED / SINGLE ADDRESS: DRIVERS LICENSE # (STREET) (CITY) (STATE) (ZIP) S.S. # / / E_MAIL: @. CELL#( ) (Required for background check) MEDICAL INFORMATION INSURANCE CARRIER: POLICY # GROUP # DATE OF MOST RECENT TETANUS SHOT / / IN CASE OF EMERGENCY NOTIFY PHONE PLEASE CHECK IF YOU HAVE HAD ANY OF THE FOLLOWING CONDITIONS: DIABETIC HEART PROBLEMS INSECT STING REACTION EPILEPTIC HIGH BLOOD PRESSURE FAINTING / DIZZY SPELLS ALLERGIES TUBES IN EARS OVERHEAT EASILY ASTHMATIC ALLERGIES: HANDICAPS/PRE-EXISTING CONDITIONS: OTHER MEDICAL FACTS WE SHOULD KNOW:
In the event that I am unable to respond and my spouse (if applicable) cannot be notified of necessary emergency surgery or other medical treatment, I desire to be treated in the manner recommended by the attending physician. The information contained in this application is correct to the best of my knowledge. I authorize any references or churches listed in this application to give you any information they may have regarding my character and fitness for children / youth work and give permission for my local church or the LA District Assemblies of God to run a criminal background check in conjunction with working with minors. SIGNATURE (REQUIRED) PASTOR S RECOMMENDATION (must be signed) I have reviewed the information being submitted, and as pastor, I highly recommend the applicant as a camp counselor / volunteer. I am personally acquainted with the applicant, and in my opinion he or she is competent and qualified to work with minors. I know of no reason physically, morally or spiritually that he / she should not be accepted. I know of no facts or allegations that raise any question concerning his / her suitability for working with minors in any activity. PASTOR S SIGNATURE PASTOR S COMMENTS BACKGROUND CHECK INFORMATION: In conformance with standard guidelines for adult volunteers working with minors, we are requesting a background check from each adult volunteer age 18 and above. This is from the National Criminal Search and Sex Offender s Database. (not a credit check). We will contact you if there is any interference in your acceptance due to the background check. This is in addition to a pastors recommendation. Please check the appropriate box below that describes your situation: I do not have a background check and request the Family Life Deparartment to process one for an additional $10 fee. I/my church have enclosed proof of my background check (which has been screened in the above mentioned areas) with this application. **Must be enclosed with application. Have you ever been convicted of (or pled guilty to) child abuse or a crime involving actual or attempted sexual molestation of a minor or adult? Yes No If yes, explain. Have you ever been convicted of (or pled guilty to) any other crimes? Yes No If yes, explain. Do you currently use alcohol, tobacco, or any illegal drugs? Yes No
2018 JUNIOR SPONSOR APPLICATION ALL SPACES MUST BE COMPLETED TO BE ACCEPTED. COUNSELOR FORMS MUST BE SENT THROUGH THE LOCAL CHURCH. JUNIOR COUNSELOR AGES 15-18. $45.00 J.C. registration fee Please indicate the camp you desire to attend T-shirt add l $10 KID S CAMP #1 DATE JULY 2-6 KID S CAMP #2 DATE JULY 8-11 adult small adult large KID S CAMP #3 DATE JULY 11-14 adult med adult XL 2X 3X NAME:(first) (middle) (last) DOB : / / AGE: MALE: FEMALE: ADDRESS: CELL (STATE) (ZIP) PHONE # ( ) E-MAIL: instagram/snapchat / / DRIVERS LICENSE # S.S. # IN CASE OF EMERGENCY NOTIFY SPONSORING CHURCH PHONE PHONE CHURCH ADDRESS Parent/Guardian Name Parent/GuardianAddress City State Z i p Parent/Guardian Home Phone ( ) work # ( )
MEDICAL / HOSPITAL INSURANCE CARRIER: POLICY # GROUP # MEDICAL HISTORY: DATE OF MOST RECENT TETANUS SHOT / / PLEASE CHECK IF YOU HAVE HAD ANY OF THE FOLLOWING CONDITIONS: DIABETIC HIGH BLOOD PRES ALLERGIES HEART PROBLEMS EPILEPTIC TUBES IN EARS ASTHMATIC FAINTING / DIZZY SPELLS OVERHEAT EASILY INSECT STING REACTION HANDICAPS OF ANY NATURE: PRE-EXISTING CONDITIONS: OTHER MEDICAL FACTS WE SHOULD KNOW: ALLERGIES: I give permission for my child to participate in all camp-related activities. I give my consent to administer prop- er medication as needed and requested by the camp nurse or other qualified authority. In the event I cannot be reached to be notified of necessary emergency surgery or other needed medical treatment, by doctor's recommendations, I desire to have my dependent treated in the manner recommended by the attending doctor. Parental signature required As a camp junior counselor applicant, I realize I may be called upon to serve in a number of areas. I will dedicate myself to the service at the camp. I realize this camp is for student. I also fully understand that my application may not be accepted due to over staffing, bed spaces, etc. The information contained in this application is correct to the best of my knowledge. I authorize any references or churches listed in this application to give you any information they may have regarding my character and fitness for children/youth work and give permission for my local church or the Louisiana District Assemblies of God to run a criminal background check. (only if age 18) JC applicant signature (required) PASTOR'S RECOMMENDATION (must have) I have reviewed the information being submitted, and as pastor, I recommend the applicant as a Junior Counselor. I am personally acquainted with the applicant, and in my opinion he or she is competent and qualified to work with minors of any age. I know of no reason physically, morally, or spiritually that he/she should not be accepted. I know of no facts or allegations that raise any question concerning his or her suitability for working with minors in any activity. Pastor s Signature Pastor s Comments
2018 Kids Camp Payment Form Use this for to pay all fees that are mailed in to the District Office. All registration forms and T shirt order forms should be submitted with this payment form. Church name: Address: City: State: Zip: Camp Coordinator: Cell Ph: ( ) - Email: Which camp you will be attending: Kid's Camp #1 -> July 2-6 (Monday-Friday) Kid's Camp #2 -> July 8-11 (Sunday-Wednesday AM) Kid's Camp #3 -> July 11-14 (Wednesday PM-Friday) Camper Registration Rates (Note: Applications must be fully completed and $50 Deposit must be Postmarked by Deadlines for Rate to be Secure): Week 1 (Long Week): Early Bird Rate by June 1 Total Fee: (Week 1) Deposit for Camper $50 x = Camper Early Bird Registration $170 x = Adult Sponsor $50 x = Regular Bird Rate by June 15 Total Fee: (Week 1) Deposit for Camper $50 x = Camper Early Bird Registration $185 x = Adult Sponsor $65 x =
Late Bird Rate by June 22 Total Fee: (Week 1) Deposit for Camper $50 x = Camper Early Bird Registration $195 x = Adult Sponsor $70 x = Week 2 and 3 (Short Week): Early Bird Rate by June 1 Total Fee: (Week 2 & 3) Deposit for Camper $50 x = Camper Early Bird Registration $155 x = Adult Sponsor $40 x = Regular Bird Rate by June 15 Total Fee: (Week 2 & 3) Deposit for Camper $50 x = Camper Early Bird Registration $170 x = Adult Sponsor $55 x = Late Bird Rate by June 22 Total Fee: (Week 2 & 3) Deposit for Camper $50 x = Camper Early Bird Registration $180 x = Adult Sponsor $60 x = JC Request (Limit 2 per church) $45 x = *Adult Background Check (18 & older) $10 x = Camp T-Shirt (if ordered by the June 1st Deadline) $10 x = *if you are requesting CHILD LIFE Department to run the background check for you. Please mail this form to: LOUISIANA ASSEMBLIES OF GOD CHILD LIFE DEPT TOTAL:
2717 N MACARTHUR DR ALEXANDRIA, LA 71303 Make checks payable to: CHILD LIFE DEPARTMENT
2018 Kid Camp Team Fun Days Kids Camp Week #1 Monday = Marvel Monday Dress up in your favorite super hero gear for added points for your team! Tuesday = Team Color Tuesday Wear your team colors for added points for your team! Wednesday = Wacky Wednesday Wear any clothes that are bright, goofy, wacky, or super-fun that make you look and feel SPECIAL for added points for your team!!) Thursday = Best Day Ever Wear any clothes that represent your church, your kids ministry, or are encouraging, Christian themed or inspiring to you to make you and other feel your best this day for added points for your team!!
2018 Kid Camp Team Fun Days Kids Camp Week #2 Sunday = Super Sunday Dress up in your favorite super hero gear for added points for your team! Monday = My Team Monday Wear your team colors for added points for your team! Tuesday = Best Day Ever Wear any clothes that represent your church, your kids ministry, or are encouraging, Christian themed or inspiring to you to make you and other feel your best this day for added points for your team! Wednesday = Wacky Wednesday Wear any clothes that are bright, goofy, wacky, super-fun that make you look and feel SPECIAL for added points for your team!!
2018 Kid Camp Team Fun Days Kids Camp Week #3 Wednesday = Wacky Wednesday Wear any clothes that are bright, goofy, wacky, super-fun that make you look and feel SPECIAL for added points for your team! Thursday = Team Color Thursday Wear your team colors for added points for your team! Friday = Best Day Ever Wear any clothes that represent your church, your kids ministry, or are encouraging, Christian themed or inspiring to you to make you and other feel your best this day for added points for your team! Saturday= Super Saturday Dress up in your favorite super hero gear for added points for your team!