Camper Registration JUNIOR CAMP (AGES 9-12/3rd-6th GRADE) Camper's name: c Male c Female Age: DOB: / / Grade next year: c Adult sponsor Parent/Guardian name: Mailing address: City: State: Zip: Email: Home phone: ( ) Emergency number: ( ) Church name: Boulevard Baptist Church Church address: 315 N. Burleson Boulevard City: Burleson State: TX Zip: 76028 Email: blvdoffice@sbcglobal.net Church phone: (817) 295-4342 Pastor's name: Mr. Paul Cooper Youth director's name: Jack Dunaway Family physician name: Physician's phone( ) Please check your week of attendance: Physician's address: c TEEN CAMP June 19-24, 2016 Please list and explain any medical conditions, medications, or allergies: þ JUNIOR CAMP July 11-15, 2016 Current daily medications:
Insurance Information JUNIOR CAMP (AGES 9-12 / 3rd-6th GRADE) Name of insurance company: Employee name: Camper SS#: Employee SS#: Employee company name and address: Group policy number: Policy number: City: Email: Or attach a photocopy of the card's front and back to this form. I give my consent for the above named camper to attend Lake Texoma Baptist Youth Camp and Conference Center. My child may participate in all camp activities. I/we will not hold the organization or its sponsors liable in case of sickness, injury, or loss of property. I/we give consent for our child to receive emergency medical treatment if necessary. We also agree to abide by all camp rules and regulations. The above named caregiver shall be authorized to consent for all medical and/or surgical treatment and/or other medical procedures (including administration of anesthesia, blood transfusions, diagnostic test, etc.), for the above named child, which may be reuired during above named child's stay at camp. This consent serves as permission for treatment by any medical facility that Lake Texoma Baptist Youth Camp and Conference Center and its counselors deem proper and necessary. NOTE: Consents are not reuired in emergency situations. I agree to pay for all services provided to my child while they are at camp. Parent/Guardian signature: Camper signature: Date:
Camper's health form for camp week dates July 11 to July 15. Camper's Name: Street: Lake Texoma Baptist Youth Camp 28613 Preston Bend Road Pottsboro, Texas 75076-3430 817-575-7360 MEDICAL FORM City: State: Zip: Immunization dates (Must have DATES for all campers under age 21) DPT POLIO HEPATITIS MMR RESTRICTIONS KNOWN ALLERGIES AUTHORIZATION TO DISPENSE PRESCRIPTION MEDICINE I hereby authorize the medical staff at Texoma Baptist Youth Camp to dispense the following prescription medicines: NOTE: ALL medications must be in original prescription bottles and dispensed by Camp Medical Staff. AUTHORIZATION FOR EMERGENCEY CARE I hereby authorize any physician licensed to practice in the State of Texas, and medical staff at Texoma Baptist Youth Camp to provide emergency medical care and give medication to the above named camper. Parent/Guardian signature: Camper signature: Date:
BOULEVARD BAPTIST CHURCH RED RIVER VALLEY BAPTIST JUNIOR CAMP 2016 - (Ages 9 to 12) When: Monday, July 11, 7 am Friday, July 15, before 2 pm Where: Lake Texoma Baptist Youth Camp, Pottsboro, TX Cost: $130.00 per camper Campers: Meet at the church 7 am Monday Breakfast: Please eat a good breakfast. Lunch and dinner will be served at camp. Food: Camp will provide 3 hot meals a day Tuesday through Thursday. The church will provide snacks. Friday: Breakfast will be served at camp and we will NOT stop for lunch on the way home. Luggage: Will be loaded and unloaded on the front porch of the Family Life Center. Please do NOT pack medication in luggage. Before Leaving: To prevent health problems, all campers will be checked for head lice before being allowed on the bus. Students will not be allowed on the bus if there is any evidence of head lice. ALL HEALTH FORMS & CAMP FEES ARE DUE BY WEDNESDAY, JULY 3rd Health Forms: Each camper must turn in a completed Health Form and Medication Form on Sunday, July 10. Medications: Do not pack any medications in your suitcase. Campers who use an asthma inhaler should keep it with them at all times. All other medications should be given to Mrs. Cooper at the registration table Monday morning. a. Keep medications in the original container. b. All medications must be placed in a one uart size freezer bag. The camp nurse will administer all medication and must have this specific information. Important Phone Numbers: Church Office: 817-295-4342 Jack Dunaway: 817-994-4751 Paul Cooper: 817-228-1339 For vocal Music or instrumental competition, contact Mary Yancy: 817-295-1693 For culottes, contact Deborah Mosby: 817-517-8558 Camp Safety: The camp complies with all Texas Health and Safety Laws. There are two or more certified lifeguards at the pool at all times. An adult sponsor will accompany all BLVD Campers to the pool area each day. The campgrounds are fenced and patrolled at night by the auxiliary law officers. The camp will provide a E.M.T. to serve as camp nurse and care for any medical needs. Camp Rules: To avoid Pink Eye and Head Lice, campers are not allowed to borrow makeup, combs, brushes, towels or pillows from others. There is a 6-inch rule between boys and girls at all times. All cell phones will be turned in to sponsors before leaving on the bus for camp. If a camper wants to call their parent they can ask their sponsor to use your phone. No cell phones or cameras are to be used by campers in the dorms. Spending Money: Campers may bring spending money for the Concession Stand. The Concession Stand will be open 3 times a day Monday through Thursday. A suggested amount would be $5 per day for a total of $20 for the week. Camp Shirts: Each camper will receive a camp shirt at camp Thursday morning. Competitions: Sport Competition This year, all campers will be assigned to a team and be given a team identification badge. The camper must wear the badge to all Team Competitions and may not change teams or swap badges for any reason. The teams are divided out at random by the camp officials.
Music Competition is limited to the following per church: 2 solos, 2 duets, 2 trios, 1 uartet, 2 piano solos, 2 instrumental solos (1 in each division) and 1 ensemble. If your child is interested in competing in one of these categories, you should contact Mary Yancy (817-295-1693) as soon as possible. Mrs. Yancy is responsible for assigning campers in music categories and her decision is final. Dress Code: Monday Morning: Please send your child Monday morning dressed for the bus ride. Girl campers should wear a t-shirt & culottes Boy campers should wear a t-shirt & long pants For Camp: Girls: Must wear culottes, skirts or dresses. Girls must bring all culottes loaned to them Hemline must come to middle of knee. No pants, shorts, mini skirts, sun dresses. No see thru blouses or spaghetti straps. No tube tops, tank tops, or tight shirts. No short shirts shirts must cover waistband when hands are lifted above their head. No bikini bathing suits; if at any time the sponsor feels that a bathing suit is immodest, the camper will be asked to wear a t-shirt over her swimsuit. A full set of clothes must be worn over your swimsuit to and from swimming pool. All clothing should be loose fitting. Shoes must be worn at all times. Ensemble clothes: Jean skirt or culottes & camp shirt Boys: Must wear long pants, jeans or wind pants. No shorts or skinny leg jeans or pants. No sleeveless, muscle, or cut off shirts. All shirts must cover waistband when hands are lifted above their head. No earrings or necklaces. A full set of clothes must be worn over your swimsuit to and from swimming pool. Shoes must be worn at all times. Ensemble clothes: Jeans & camp shirt. Music Competition: All campers are reuired to wear dress clothes Girls-dress or nice skirt and blouse with nice shoes Boys-dress pants, shirt, tie and nice shoes Tips for Belongings: Use masking tape to label all of your camper s belongings. Some parents like to tape a list of what the camper brought in the top of his or her suitcase. A permanent marker should be used to label clothing tags, towels, etc. A plastic trash bag makes a good dirty clothes bag. Tell your child not to loan or borrow hairbrushes, pillows, grooming items, clothing or etc.
WHAT TO PACK Things To Take: (Labeled with name!) Things NOT To Take: OPTIONAL: King James Bible, Notepad & pen Bedding, 1 pillow, 1 blanket & alarm clock Towels, wash cloths, toiletries Swimsuit, robe, sunscreen 5 pairs of sports clothes 4 pairs of church clothes Shoes, light jacket, umbrella 6 pack of bottled water Baseball glove, bat, softball Ping pong paddle, basketball NOTE: Books or magazines Radio, MP3, CD player, tapes, earphones Video games or card games Water guns or pranks of any kind Knives or weapons of any kind *These items will be taken away from any camper and will not be returned until we get home! LAKE TEXOMA BAPTIST YOUTH CAMP 28613 Preston Bend Rd. Pottsboro, TX 75076-3430 903-786-2734 Directions: Take I-35 N Stay on I-35 and take exit 498 in Gainesville Follow US 82 E and TX-289 N to Preston Bend Rd in Grayson County The camp is surrounded by a white fence and will be on the left hand side.