2016 PowerPlus Preteen Camp Pineywoods Baptist Encampment Church MEDICAL RELEASE & ACKNOWLEDGMENT Church City Camp Session: Session 1 / June 26-29 Session 2 / June 29-July 2 Legal Name Social Security # First, Middle, and Last Preferred Name SS# is not required by Pineywoods Encampment. If camper is sent to a clinic or hospital, the SS# will be required before the patient is admitted. Address City State Zip Gender F M Age at Camp Birthdate (mm/dd/yyyy) (Sponsors MUST be 18 years old or older) Emergency Contact Name Relationship to Camper Home Phone Cell Phone Email Alternate Contact Name Relationship to Camper Home Phone Cell Phone Email Pertinent Medical History/Condition(s) & Special Instructions (Attach additional page if necessary.) Known Allergies Current Medications & Instructions. (All medication, both prescription and non-prescription, must be checked in with the camp medic upon arrival. Prescription medication must be in the prescribed container.) FILL IN THE CONTACT INFORMATION BELOW IF PRESENTLY UNDER A DOCTOR S CARE. Doctor s Name Phone Address City State Zip AUTHORIZATION I have read and understand the camp rules. I agree that my child (or I) will abide by them while at Pineywoods Baptist Encampment. If my child (or I) does (do) not abide by these rules, I understand that he/she (or I) could be sent home at my expense at the discretion of the camp director and camp administration. I also consent & give permission for the use of photographs of my child (or myself) taken while at camp to be used in the promotion of Pineywoods Baptist Encampment on the Pineywoods Camp web page or printed materials. Parent/Guardian: I hereby give my consent for the above named camper to take part in any and all activities occurring within the camp program. I hereby give my permission for medical treatment, including administration of first aid and/or OTC medication(s), if deemed necessary by camp medical personnel. If in the event of an emergency, I cannot be reached, I hereby give my consent for Pineywoods camp administration or church leadership to sign for and obtain emergency medical care should it be necessary. I understand that every effort will be made to provide the safest camp environment possible, but that accidents can and do occur. I agree not to hold liable the sponsoring church, the camp staff, or Pineywoods in the case of an unforeseen event at camp or within the camp program. Sponsor: In the event of an emergency I hereby give my consent for Pineywoods camp administration or church leadership to sign for and obtain emergency medical care should it be necessary. I understand that every effort will be made to provide the safest camp environment possible, but that accidents can and do occur. I agree not to hold liable the sponsoring church, the camp staff, or Pineywoods in the case of an unforeseen event at camp or within the camp program. PARENT/GUARDIAN SIGNATURE (Or Self if a Sponsor) RELATIONSHIP TO CAMPER: PARENT GUARDIAN SELF (Must check one)
POWERPLUS CAMP RULES (revised 2/7/14) PLEASE READ AND SIGN AT BOTTOM OF MEDICAL RELEASE & ACKNOWLEDGMENT Pineywoods is a Christian camp and all rules are to help us to reflect Christ in our conduct. Please respect all camp properties just as you would at the church you attend. We ask you to assist in keeping the grounds clean of trash. Cans are provided camp wide to contain debris. Illegal drugs, alcohol, knives, ANY form of tobacco, guns, skateboards, and fireworks are not permitted. Such items will be confiscated. If property or equipment is damaged, your group will be held responsible for any cost incurred for repair or replacement. If dorm room is excessively filthy during your stay or upon departure, your church will be assessed a fine of at least $50. Cell Phone Policy for STUDENTS: Students are not allowed to possess cell phones at camp. Possess means carry on their person, keep in their luggage, or otherwise have access to without the supervision of a sponsor. Cell Phone Policy for SPONSORS: Sponsors must not allow cell phones to distract others or themselves from the camp program. Phone usage must be limited to only absolutely necessary calls, messages, or internet activity while at camp. Adults may use phones for note-taking, Bible reading & appropriate image capturing while at camp. The lake is for canoeing, kayaking, or fishing. The lake is not approved by the Health Department for swimming. A lifeguard must be present, and lifejackets worn while a camper is in any boat. Pineywoods requires two adult sponsors in each dorm room. Sponsors must be at least 18 years old (19 for youth camp), have a current criminal/sex offender background check, be approved by their church pastor, and have completed Child Protection Training before coming to camp. Shaving cream fights, water fights, etc. will not be tolerated. A group doing such in or near enough a building to cause damage, will face a charge of at least $100. No use of the Ropes Course or pool is allowed unless Pineywoods authorized, trained personnel are present. Shoes must be worn at all times (unless a camper is in the pool or on sand volleyball courts). No clothing which is revealing, suggestive, or advertises alcohol or tobacco products will be allowed. Swimsuits must be modest no bikini- or monokini-style or a colored t-shirt must be worn while at the pool. Lifeguards have discretion and can eject anyone not properly clothed from pool area. No hats are to be worn during worship. No spaghetti strap garments will be allowed. PDA will not be tolerated (public or private). Campers are not allowed to enter dorms of campers of the opposite sex. Campers are not allowed to leave the campgrounds while attending camp (unless with Missions group). Campers must attend all scheduled sessions and activities throughout the week. Campers are not allowed to ride in or on any vehicle during the camp (unless en-route to mission project with Missions group). Campers are not allowed to share ANY medication belonging to them with any other camper all medication (prescription and non-prescription) must be checked in with the camp medic upon arrival. Prescription medication must be in the prescribed container. No golf carts, four-wheelers, or ATVs of any kind are allowed on camp except those used by the camp staff or unless pre-approved by camp management. All guests must check in at the camp office and have a completed, current criminal/sex offender background check before moving about the camp. All of the above rules are designed to provide a Christian atmosphere, a safe and healthy environment, and provide for the respect of the camp and facilities. Please see to it that all campers are aware of these rules before your session begins. Pineywoods carries an accident policy on registered guests. This policy is intended to supplement your own insurance, and will pay only to its limits. There is no deductible. Sickness and pre-existing conditions are not covered. This policy will pay only for accidents immediately reported to Pineywoods. This insurance does not cover members who leave the grounds during your stay. Unauthorized activities may not be covered. Claims must be reported on forms provided by Pineywoods.
PowerPlus Preteen Camp 2016 Facts Sheet Pineywoods Baptist Encampment (12 miles west of Corrigan, Texas on US HWY 287) June 26-29, Sunday-Wednesday BETHEL BAPTIST CHURCH R E A D C A R E F U L L Y IMPORTANT PHONE NUMBERS: Bethel Baptist Church... 281-689-3958 Tim Davis... 281-687-5005 Julie Davis... 281-687-0042 John Turner... 832-233-2974 Lori Bauer... 281-536-9946 Pineywoods Baptist Encampment... 936-642-1723 BASIC BETHEL GUIDELINES: R E A D V E R Y C A R E F U L L Y The following rules are strictly enforced at camp! Breaking of ANY of these rules, or the rules found on back of the Pineywoods Medical Release & Acknowledgment Form, can result in the expulsion of the camper. Obedience to Pineywoods & PowerPlus rules is NOT optional. NO cutting in line or reserving places in meal lines. NO weapons, tobacco products, alcohol, drugs, radios, CD players, ipods, video games, etc. NO PILLOW FIGHTS, TOWEL FIGHTS OR PRACTICAL JOKES. NO tank tops. All shorts must be a modest fingertip-length. Skirts must be modest, at least approaching the knees. At NO time should undergarments or belly buttons be seen. Swimsuits must be one piece or be worn under a cover up at all times. NO public or private displays of affection or aggression (PDA) will be allowed in the Bethel group. If you are ill or injured, you must go to the camp nurse. If you cannot participate in the camp schedule, you must go to the camp nurse. Every camper will participate in the total camp. If a camper refuses to follow the instructions of the camp, an adult sponsor, or Bethel representative, he will be sent home at his parent s expense. BETHEL SCHEDULE: Sunday 9:30-10:30 am Load Your Belongings into the Trailer 12:30 pm (IMMEDIATELY following Worship) Change Clothes, Load the Bus & Leave EAT YOUR SACK LUNCH ON THE WAY *** For the trip to camp: bring a sack lunch & a drink, & comfortable clothes to change into immediately following Sunday Morning Worship. We will NOT stop for eats on the way to camp. There will NOT be time for you to go home after Sunday Morning Worship. *** ALL MEDICATION must be in its original bottle, placed in a clear zip-loc bag, with the camper s name printed on the bag with a permanent marker. DO NOT pack medication in your suitcase. Please give ALL medication to the designated adult sponsor before boarding the church bus. (The camp nurse will dispense all medications during camp. Campers must go to the Nurses Station to receive their medications.) Wednesday Camp officially ends after lunch on Wednesday. Your child will call for a ride when they reach the church. Please make sure your child knows whom to call, and how to reach them for a ride home on Wednesday. Please read all of the information on the back of this page very carefully. If you have any questions, please call or text me at 281-687-5005, or email me at timandjulie93@yahoo.com. I m looking forward to an AMAZING time in our Lord! Tim Davis
2016 PowerPlus Preteen Camp WHAT TO BRING A Bible and a Pen Shorts (finger tip length) and shirts Sleepwear Socks and underwear Athletic shoes or sandals Extra clothes and shoes that can get wet and muddy during Crazy Games (dark colors only) Modest swimwear (a 2-piece must have a dark T-shirt over it), sunscreen, sunglasses Towels and washcloths Toiletries - soap, shampoo, toothbrush, toothpaste, deodorant Sheets (twin sized) or sleeping bag and pillow Spending money for Snack Shack & Gift Shop Offering money for missionary project WHAT NOT TO BRING Cell phones, ipods, or similar devices Non-prescription drugs (common OTC drugs are available in the First Aid Station at no charge) Alcohol or tobacco products (including dip) Guns, knives or fireworks Bikinis or Speedo-type swim suits Short shorts or see-through clothing Halter tops, spaghetti straps, or shirts that don t cover the midriff Clothing which is revealing, suggestive, or advertises alcohol or tobacco products Arrival Rec Day 1 (2:00-4:20) As soon as campers get their stuff in their dorms and get a wristband, they can choose any of these activities: The pool, bungee bull, climbing tower, pedal car racing, canoes, kayaks, fishing, basketball, ping pong, and more. CAMP SCHEDULE (as of 9/30/15) Day 1 2:00 Check In/Arrival Rec 4:20 Clean Up for Supper...Dorms 4:45 Student Orientation...Tabernacle Sponsor Orientation...Hyde Hall 5:30 Supper... Yellow 5:30, Green 5:40, Red 5:50 7:00 Worship...3rd-5th Tabernacle/6th Ogletree 8:15 Church Group Time 8:45 Evening Break... Snack Shack open til 9:15 9:30 LOL (Laugh Out Loud)... Rec Field 10:30 Go to Dorms...Dorms 10:55 Dorm Devotion...Dorms 11:00 Lights Out Day 2 & 3 7:00 Wake Up & Clean Up...Dorms 7:45 Breakfast...Red 7:45, Yellow 7:55, Green 8:05 Sponsor Breakfast / Hyde Hall (1 rep. from each church) 9:00 Power Rally & Missions Adventure...Tabernacle 9:45 Block 1: Yellow - Crazy Games / Green - Free Time / Red - Bible Study & Free Time 11:25 Clean Up for Lunch...Dorms 12:00 Lunch...Green 12:00, Red 12:10, Yellow 12:20 1:30 Block 2: Yellow - Free Time / Green - Bible Study & Free Time / Red - Crazy Games 3:10 Get Ready for Block 3 3:20 Block 3: Yellow - Bible Study & Free Time / Green - Crazy Games / Red - Free Time 4:50 Clean Up for Supper...Dorms 5:30 Supper... Yellow 5:30, Green 5:40, Red 5:50 7:00 Worship...3rd-5th Tabernacle/6th Ogletree 8:15 Church Group Time 8:45 Evening Break...Snack Shack open til 9:15 9:30 LOL (Laugh Out Loud)... Tabernacle 10:30 Go to Dorms...Dorms 10:55 Dorm Devotion...Dorms 11:00 Lights Out 6th Grade Night Swim Night 3 10:15-11:15 Day 4 7:00 Wake Up, Pack Up & Clean Up...Dorms NOTE: Dorms are to be empty when you go to breakfast!!! 7:45 Breakfast...Red 7:45, Yellow 7:55, Green 8:05 9:30 Super Celebration...Tabernacle 11:00 Express Lunch...Green 11:00, Red 11:10, Yellow 11:20 Block Times: (100 minutes) Every church will be assigned to one of three color groups. At each of the three Block times, the color groups will be assigned to one of the three activities below. Crazy Games - Recreation Field Free Time Your choice - the pool, crafts, pedal cars, canoes, kayaks, fishing, basketball, ping pong, talent show audition, Giant Swing, Climbing Tower, Snack Shack Bible Study & Free Time