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Indian Cave Youth Camp
2015
2015 Camp Dates and Prices
Junior Camp: June 15-19
Ages 7-12 $160 – Ages 5-6 $100 – Adults and Youth Workers $75
College Weekend: June 19-21
High School Juniors and Seniors thru age 24 - $60
Senior Camp: June 21-26
Ages 12-18 (6th-12th grades) $160 – Adults $75
Camp Hope: July 22-26
Ages 8-12 – Scholarship Only
Is there a deadline?
Yes! Camp tends to fill up fast. The deadline to register for all camps except Camp Hope is June 1. You can register
after June 1, but the price increases $30 and you will not be guaranteed a spot.
.
Where do I get my forms?
1) You can download brochures and forms online at www.emchurch.org
2) You can also register online at the website above.
The Registration Process
There are 2 ways you can register for camp
1) Register and/or pay online. Bring registration forms with you when you come to camp.
2) Mail registration forms with deposit by the deadline.
3) It would help us greatly if you paid both your deposit and registrations with one church check. Make all checks
payable to “Indian Cave Youth Camp”
Where do I mail my forms for all camps?
Mail all forms to:
Brian Gordon ([email protected])
1920 Lucas Street
Salem, VA 24153
Good Things to Know
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Things to Know About Registration
Your deposit ($30 per camper and adult) is non-refundable, but you may substitute one camper for another if you
need to make changes to your camp roster.
The deposit amount is included in the camp fee. So, when you come to camp your amount due will be your total
original registration cost minus your deposit paid.
If you register after June 1 you may not be guaranteed space and your registration fee will increase by $30 per
person.
When you arrive at camp come to the chapel first to finish registration and to receive your cabin assignments.
Things to Share With Your Campers
If you have special food restrictions/allergies be sure to communicate that clearly before you arrive at camp so we
can make arrangements for you.
Be sure to go over the camp rules so everyone will know what is expected when they arrive on campus.
Prescription medications must be kept in the dining hall, so you will need to turn them in (clearly marked and
labeled) when you arrive for registration.
Teenagers (and kids) spend half their lives on their cell phone. We ask that teens abstain from using their phones
except for taking pictures. Withdrawal won’t be that bad and you may even realize it’s kind of cool to talk to your
friends face-to-face!
We know camp is a fun and safe place to meet the opposite sex, but we limit PDA (public displays of affection) to
hand holding only. And when you are in the chapel, hands off. We want you to focus on God and not how soft your
girlfriend’s hand is.
Paintball
1) If anyone in your group wants to play paintball they cannot play unless their registration form is marked and
signed by a parent.
2) We provide paintball guns, paintballs, goggles and CO2 canisters. Your teens will need to bring clothes to play
paintball in. Teens are not allowed to bring their own guns.
INDIAN CAVE YOUTH CAMP
2015 JUNIOR CAMP WORKER REGISTRATION & MEDICAL RELEASE
JUNE 15 – 19
$75 if payment & registration is postmarked by June 1st , $105 after June 1st
PLEASE CHECK OPTION THAT APPLIES TO YOU - ___ Adult Worker (21+) ___ Junior Worker (16-19)
MAKE ALL CHECKS PAYABLE TO: INDIAN CAVE YOUTH CAMP
If not using online registration form
PLEASE MAIL REGISTRATION FORMS WITH PAYMENT TO:
ATTN: JUNIOR CAMP
1920 LUCAS STREET
SALEM, VA 24153
Please print or type each line of this for and mail with full payment by June 1st. If registering online bring form with you
Workers Name: ____________________________________________
Male _____
Female _____
Mailing Address: _______________________ Physical Address if different: _________________________________
City: _____________________ State: __________ Zip Code: ____________
Social Security # (required for medical treatment) ____ - ____ - _____ Birthdate: ____ / ____ /_____ Age: _____
Cell #: ____________ Home #: ____________ Work #: ____________
Email Address to receive Information updates: _______________________ @ _____________________ . ________
T-Shirt Size (shirts are adult sizes) S M L XL 2XL 3XL
Which Church are you attending with? ________________ City: _____________ Pastor: ____________________
Do you have any kids who are Junior campers? Yes _____ No _____ If yes, please list below:
(We Need To Have Registration Forms Filled Out For Each Child)
Name: ____________________
Age: ________ Boy: _____ Girl _____
Name: ____________________
Age: ________ Boy: _____ Girl _____
Name: ____________________
Age: ________ Boy: _____ Girl _____
Name: ____________________
Age: ________ Boy: _____ Girl _____
Name: ____________________
Age: ________ Boy: _____ Girl _____
In case of an emergency, is there someone else we can notify?
Name: _________________________ Phone #: ____________________ Relationship to you: __________________
MEDICAL RELEASE: I; the undersigned, give the EMC Conference permission to obtain, in the case of an
emergency, medical or surgical care in the event such is necessary.
General Health of Worker: __________________________________________________________________________
Physical Handicaps: _______________________________________________________________________________
Limitations: ______________________________________________________________________________________
Allergies: ________________________________________________________________________________________
Medications: _____________________________________________________________________________________
Special Diet: _____________________________________________________________________________________
Are the following immunizations current?
Tetanus: Yes _____ No _____
MMR:
Yes _____ No _____
Polio: Yes _____ No _____
Dip Series: Yes _____ No _____
Pediatrician’s Name: _____________________ Address: ____________________ Phone: ______________
Insurance Company Name: ________________________
Insurance Policy Number: _______________________
I, the undersigned, have read & completed the entire registration form, affirm that I have been honest & accurate with the
information provided and agree to the Camp Rules. I also consent to a Background Check, which may be conducted at
the sole discretion of the Board of Youth Activities and the Indian Cave Youth Camp Board.
Worker’s Signature: ______________________________________________ Date: ___________________________
Mark which of the following activities you are willing to help plan, lead, or participate in during Junior Camp:
____ Games
____ Pool Monitor
____ Paddle Boat Leader
____ Cabin Leader
____ Canteen Worker
____ Team Leader
____ Crafts
____ Drama/Skits
____ Gym Leader
____ Bible Monologue
____ Campfire
____ Teacher
____ Willing to be with kids from another church if needed
Service Projects: ____ (We will have several different service projects for the kids to choose from)
INDIAN CAVE YOUTH CAMP
2015 JUNIOR CAMP KID REGISTRATION & MEDICAL RELEASE
JUNE 15 – 19 (PLEASE CHECK APPROPRIATE AGE GROUP BELOW)
Camper Ages – 7-12
**Kids under 4 are Free**
Pre-Camper Ages 5 - 6 – $100.00
$160 if registration and deposit is made by June 1st, $190.00 after June 1st
(This includes Lodging, Meals, Canteen Breaks and a T-Shirt)
MAKE ALL CHECKS PAYABLE TO: INDIAN CAVE YOUTH CAMP
If registering online bring this form with you, if not registering online:
MAIL REGISTRATION FORMS WITH $30.00 DEPOSIT/FULL PAYMENT TO:
ATTN: JUNIOR CAMP
1920 LUCAS STREET
SALEM, VA 24153
For More Information Contact Brian Gordon - Phone Number: 540-892-9278 EMAIL: [email protected]
Please print or type each line of this for and return with $30.00 deposit/total cost by June 1st.
Camper’s Name: ___________________________________________
Male _____
Female _____
Mailing Address: ___________________________
Physical Address if different: ____________________________
City: ______________________ State: __________ Zip Code: _________ Grade Next Year: ______________
Social Security # (required for medical treatment) _____ - ____ - _______ Birthdate: ____ / ____ /______ Age: _____
Youth T-Shirt Size
S M L XL
or
Adult T-Shirt Size S M L XL 2XL 3XL
Which Church are you attending with? _____________________ City: ________________
Parent/Guardian’s Name: ____________________ Cell #: __________ Home #: __________ Work #: __________
Email Address to receive Information updates: _______________________ @ _____________________ . ________
In case of an emergency, and we are unable to contact above name, is there someone else we can notify?
Name: _________________________ Phone #: _________________ Relationship to Camper: __________________
MEDICAL RELEASE: I, the undersigned am the legal parent and/or guardian of ___________________, and I give
him/her permission to participate fully in Camp Activities. I also release ICYC from all liability while my child is
participating in Camp Activities. I give the EMC Conference permission to obtain, in an emergency, medical or surgical
care for him/her in the event that I cannot be reached and such is necessary. I understand that every effort will be made
to locate me in the case of such an emergency.
General Health of Camper: __________________________________________________________________________
Physical Handicaps: _______________________________________________________________________________
Limitations: _______________________________________________________________________________________
Allergies: ________________________________________________________________________________________
Medications: ______________________________________________________________________________________
Special Diet:
________________________________________________________________________________________________
Is this camper able to participate in all camp activities (such as swimming, field games, running, etc) Yes ______ No: ______
If answer is no, please explain what activities are to be eliminated. ___________________________________________
_________________________________________________________________________________________________
Are the following immunizations current?
Tetanus: Yes _____ No _____
MMR:
Yes _____ No _____
Polio: Yes _____ No _____
Dip Series: Yes _____ No _____
Pediatrician’s Name: _____________________ Address: ____________________ Phone: _________________
Insurance Company Name: ______________________
Insurance Policy Number: _______________________
We, the undersigned, have completed the entire registration form, affirm that I have been honest & accurate with the
information provided and agree to the Camp Rules. We also agree to allow any pictures taken to be used in publications
or for promotional purposes.
Parent/Guardian’s Signature: ______________________________________ Date: ___________________________
Camper’s Signature: _____________________________________________ Date: ___________________________
Indian Cave Youth Camp
COLLEGE WEEKEND REGISTRATION
Cost for College Weekend is $60
MAKE CHECKS PAYABLE TO: Indian Cave Youth Camp
Youth Leadership Boot Camp is open to Juniors and Seniors in High School thru age 24
JUNE 19 – JUNE 21, 2015
DEADLINE TO REGISTER IS JUNE 1, 2015
If not using the quick registration form mail forms with deposit to:
REV. BRIAN GORDON
1920 LUCAS ST.
SALEM, VA 24153
PHONE NUMBER (540) 387-0326
Please complete each line of this form and pay $30.00 deposit or total cost by the cut-off date
Make all checks payable to: Indian Cave Youth Camp
Underline the name you answer to or include your nickname:
Camper’s Name_________________________________________________________Male ____Female____
Address______________________________________________________________________________
City________________________________________State_____________________Zip_____________
Social Security No (required for medical purposes) _____________________________________Grade Next Year_______________
Birthdate ________________ Age _____ T-shirt size (adult sizes only) S M L XL XXL XXXL
What church did you come with?__________________________________ City__________________________
Parent or Guardian ___________________________________ Same address as above? If not, list _______
Home Phone (
)
Work Phone (
)________________________________
In case of emergency, is there someone other than above to notify?
Name _________________________________ Phone No. _____________________________________
MEDICAL RELEASE: I, the undersigned am the legal parent and/or guardian of_____________________________, and I give
him/her permission to participate fully in Indian Cave Youth Camp (ICYC) Activities. I also release ICYC from all liability while my
child is participating in Camp Activities. I give ICYC permission to obtain, in an emergency, medical or surgical care for him/her in
the event I cannot be reached and such is necessary. I understand that every effort will be made to locate me in case of such an
emergency.
The following information is needed for the Camp Nurse:
General Health of Camper_____________________________________________________________________________
Physical Handicaps__________________________________________________________________________________
Limitations ________________________________________________________________________________________
Special Diet _______________________________________________________________________________________
Allergies __________________________________________________________________________________________
Medication_________________________________________________________________________________________
Are the following immunizations current?
Tetanus: yes____ no____ MMR: yes____ no____ Polio: yes____ no____ Dip Series: yes____ no____
Your family physician__________________________________________________________
Physician’s address____________________________________________________________
Physician’s phone number (___)__________________________________________________
Your insurance company________________________________________________________
Insurance policy number________________________________________________________
Is camper able to participate in all camp programs?
Yes _____
No ______
If no, which activities are eliminated? ___________________________________________________________________
Is camper allowed to participate in paintball (optional and costs extra)?
Yes_____
No_____
We, the undersigned, have completed the entire registration form and agree to the Camp Rules.
Camper’s Signature____________________________________________________________ Date_______________
Parent’s (or Guardian’s) Signature if under 18_______________________________________ Date_______________
I am the Pastor/Youth Pastor of _____________________, and I recommend him/her for Youth Leadership Bootcamp
Leader Signature_____________________________________________
Date____________________
Indian Cave Youth Camp
SENIOR CAMP WORKER REGISTRATION FORM
Early Registration Rate is $75.00, $105.00 after June 1
MAKE CHECKS PAYABLE TO: Indian Cave Youth Camp
JUNE 21 – JUNE 26, 2015
DEADLINE EARLY REGISTRATION RATE IS JUNE 1, 2015
Mail Registration with Deposit unless registering online. If you register online bring this form with you
BRIAN GORDON
1920 LUCAS ST.
SALEM, VA 24153
PHONE NUMBER (540) 387-0326
Email: [email protected]
Please complete each line of this form and return with $30 deposit or full amount by June 3.
If possible, please pay with one church check.
Underline the name you answer to or include your nickname:
Worker’s Name________________________________________________________Male ___Female___
Address______________________________________________________________________________
City________________________________________State_____________________Zip_____________
Social Security No. _________________________________________Age___________________
What church are you with?_______________________________Pastor ____________________________
Home Phone (
)
T-shirt size (adult sizes only) S M L XL XXL XXXL
In case of emergency, is there someone other than above to notify?
Name _________________________________ Phone No. _____________________________________
MEDICAL RELEASE: I, the undersigned give Indian Cave Youth Camp permission to obtain, in an emergency,
medical or surgical care in the event such is necessary.
The following information is needed for the Camp Nurse:
General Health of Worker___________________________________________________________________
Physical Handicaps________________________________________________________________________
Limitations _______________________________________________________________________________
Special Diet ______________________________________________________________________________
Allergies ________________________________________________________________________________
Medication_______________________________________________________________________________
Are the following immunizations current?
Tetanus: yes____ no____
MMR: yes____ no____
Polio: yes____ no____
Dip Series: yes____ no____
Your family physician__________________________________________________________
Physician’s address____________________________________________________________
Physician’s phone number (___)__________________________________________________
Your insurance company________________________________________________________
Insurance policy number________________________________________________________
I, the undersigned, have read and completed the entire registration form and agree to the Camp Rules.
I also consent to a Background Check, which may be conducted at the sole discretion of the Indian Cave
Youth Camp Board.
Worker’s Signature____________________________________________________________
Date________________________________________________________________________
Check which of the following activities you are willing to help plan, lead, or participate in during Senior Camp:
_____ Games/Activities
_____ Help in the kitchen
_____ Crafts
_____ Worship/Praise Band
_____ Morning Devotions
_____ Stay in a cabin with kids from
_____ Teach a seminar
_____ Cabin Leader
another church if needed
_____ Sing a special
_____ Participate in drama
_____Oversee Paintball
_____ Platform manager
_____ Campfire
_____ Pool Monitor
_____ Team Leader
Indian Cave Youth Camp
SENIOR CAMP REGISTRATION FORM
Early Bird Rate is $160.00, which includes a t-shirt. $190 if registered after June 1, t-shirt not guaranteed
MAKE CHECKS PAYABLE TO: Indian Cave Youth Camp
SENIOR CAMP AGES 13 – 18 (12-13 year olds may choose either Junior or Senior Camp)
JUNE 21 – JUNE 26, 2015
DEADLINE FOR EARLY REGISTRATION RATE IS JUNE 1, 2015
If not registering online mail forms with deposit to. If you register online bring this form with you:
ATT. SENIOR CAMP
1920 LUCAS ST.
SALEM, VA 24153
PHONE NUMBER (540) 387-0326
Please fill this form out completely. Pay $30.00 deposit or total cost by the cut-off date for early registration.
Make all checks payable to: Indian Cave Youth Camp
Underline the name you answer to or include your nickname:
Camper’s Name_________________________________________________________Male ____Female____
Address______________________________________________________________________________
City________________________________________State_____________________Zip_____________
Social Security No (required for medical purposes) _____________________________________Grade Next Year_______________
Birthdate ________________ Age _____ T-shirt size (adult sizes only) S M L XL XXL XXXL
What church did you come with?__________________________________ __________________
Parent or Guardian ___________________________________ Same address as above? If not, list _______
Home Phone (
)
Work Phone (
)________________________________
In case of emergency, is there someone other than above to notify?
Name _________________________________ Phone No. _____________________________________
MEDICAL RELEASE: I, the undersigned am the legal parent and/or guardian of_____________________________, and I give
him/her permission to participate fully in Indian Cave Youth Camp (ICYC) activities. I also release ICYC from all liability while my
child is participating in Camp Activities. I give ICYC permission to obtain, in an emergency, medical or surgical care for him/her in
the event I cannot be reached and such is necessary. I understand that every effort will be made to locate me in case of such an
emergency.
The following information is needed for the Camp Nurse:
General Health of Camper_____________________________________________________________________
Physical Handicaps__________________________________________________________________________
Limitations ________________________________________________________________________________
Special Diet ________________________________________________________________________________
Allergies __________________________________________________________________________________
Medication_________________________________________________________________________________
Is camper able to participate in all camp programs? (swimming, field games, etc.)
Yes _____
No ______
If no, which activities are eliminated? __________________________________________________________
_________________________________________________________________________________________
Are the following immunizations current?
Tetanus: yes____ no____
MMR: yes____ no____
Polio: yes____ no____
Dip Series: yes____ no____
Your family physician__________________________________________________________
Physician’s address____________________________________________________________
Physician’s phone number (___)__________________________________________________
Your insurance company________________________________________________________
Insurance policy number________________________________________________________
Is camper allowed to participate in paintball (optional and costs extra)? Yes_____ No_____
We, the undersigned, have completed the entire registration form and agree to the Camp Rules. We also agree to allow
our child(ren)’s picture to be used in Camp publications and for other promotional purposes.
Camper’s Signature____________________________________________________________ Date_______________
Parent’s (or Guardian’s) Signature_________________________________________________ Date_______________
CAMP RULES
1. If we simply obey God’s Law of Love & be “Ladies & Gentlemen”….We won’t need any
other rule. Hebrews 12:14 “Make every effort to live in peace with all men and to be
Holy; without Holiness no one will see the Lord.”
2. EVERYONE UP & AT ALL MEALS ON TIME.
3. NO CAMPER WILL LEAVE THE GROUNDS WITHOUT PERMISSION.
4. ALL CAMPERS WILL BE REQUIRED TO ATTEND ALL ACTIVITIES & SERVICES.
5. DRESS CODE:
A. Both boys & girls will be fully dressed at ALL TIMES.
I. ALL shorts/skorts must have a 6” inseam.
B. SHOES/ SNEAKERS/FLIP FLOPS are required to be worn at ALL TIMES.
C. ALL tops, shirts, blouses, etc. should have sleeves or thick straps. No string straps.
(This includes times of play)
I. NO shirts that bare midriff; even when arms are raised will be allowed.
II. NO underwear is to be shown at any time.
III. ALL pants are to be worn properly and not sagging.
D. EVERYONE will clean up for all evening services.
6. NO SMOKING OR TOBACCO PRODUCTS OF ANY KIND WILL BE ALLOWED ON
THE
GROUNDS. Campers violating this rule will be subject to being sent home immediately.
7. NO ALCOHOLIC BEVERAGES, DRUGS OR ILLEGAL SUBSTANCES WILL BE
ALLOWED
ON THE GROUNDS. Campers violating this rule will be subject to being sent home
immediately.
8. ALL ELECTRONIC DEVICES MUST BE LEFT IN LUGGAGE UNLESS GIVEN
PERMISSION
BY THE CAMP DEAN.
9. CAMPERS ARE NOT ALLOWED TO USE THE PHONE; except in the case of an
emergency…so please don’t ask!
10. Due to the possibility of injury & insurance problems; NO CAMPER IS ALLOWED OUTSIDE
OF THE CABINS AFTER LIGHTS OUT; unless going to the restrooms with a Cabin Leader’s
permission. Violators of this rule will be subject to being sent home immediately.
ANY & ALL questions/concerns with a camper or Staff Member are to be taken to the Camp Dean.
Staff Members will need to consult with the Camp Dean with any questions concerning these and all
matters. All Staff Members are to uphold all rules and do not have the authority to alter or make
changes to the rules.
EXAMPLES OF THINGS TO BRING TO CAMP: toothbrush, toothpaste, soap, deodorant, towels &
washcloths, pillow & linens/sleeping bag, flashlight, Bible, notebook & pencil/pen
Paintball Rules/Release – Indian Cave Youth Camp
Safety First
1. Goggles must be worn at all times during gameplay and until the official gives permission to take them off.
2. While traveling to and from the paintball field your gun must remain in “barrel down” position with the safety on.
Failure to comply will result in immediate loss of paintball privileges.
3. Do not discharge your gun, even if it is empty, until the official begins the game. If you discharge your gun anywhere
other than the playing field you will lose paintball privileges.
4. You are not allowed to shoot at an opponent at less than 15 feet. Failure to comply will result in immediate
disqualification and loss of paintball privileges.
5. We highly recommend long sleeve shirts and long pants during game play. You play at your own risk if you do
otherwise.
Game Rules
1. The officials are in charge at all times. No game is to be played without officials. The official starts the game, ends
the game, and has the right to pause the game at any time. If at any time the official yells “TIME OUT” or “PAINT
CHECK” you must immediately lower your gun and place it in safety position.
2. There are three modes of game play: capture the flag, team elimination, and all out war.
a. Capture the flag – teams will begin on opposite sides of the playing field at home base. They will attempt
to capture the flag in the middle of the playing field and bring it back to home base.
b. Team Elimination – Teams will begin on opposite sides of the playing field and attempt to “eliminate” the
other team.
c. All Out War – Individuals spread out anywhere on the playing field and shoot until the last man or
woman is standing.
3. The official decides the mode of game play before the game begins.
4. Any hit that produces a paint splatter anywhere on your body is considered a hit (splatter residue does not count).
5. If you are hit you must raise your gun above your head and declare “DEAD MAN” as you walk directly to the
designated “out” location. Leave your goggles on until given permission by the official to remove them.
6. If you hit an official accidentally you are disqualified for that round. If you purposely shoot at an official you will
lose paintball privileges.
Release
In consideration of Indian Cave Youth Camp furnishing services and equipment to enable me to participate in Paintball I
agree as follows:
I fully understand and acknowledge that; (a) risks and dangers exist in my use of Paintball equipment and my participation in
Paintball; (b) my participation in such activities and use of such equipment may result in my injury or illness including but not
limited to bodily injury, disease strains, fractures, partial and/or total paralysis, eye injury, blindness, heat stroke, heart attack,
death or other ailments that could cause serious disability; (c) these risks and dangers may be caused by the negligence of the
participants, the negligence of others, accidents, breaches of contract, the forces of nature or other causes. These risks and dangers
may arise from foreseeable or unforeseeable causes; and (d) by my participation in these activities and/or use of equipment, I
hereby assume all risks and dangers and all responsibility for any losses and/or damages.
I, on behalf of myself, my personal representatives and my heirs, hereby voluntarily agree to release, waive, discharge, hold
harmless, defend and indemnify Indian Cave Youth Camp, and it’s owners, agents, officers and employees from any and all
claims, actions or losses for bodily injury, property damage, wrongful death, loss of services or otherwise which may arise out of my
use of Paintball equipment or my participation in Paintball activities.
I HAVE READ THE ABOVE WAIVER AND RELEASE AND BY SIGNING IT AGREE IT IS MY INTENTION TO EXEMPT AND RELIEVE INDIAN CAVE
YOUTH CAMP FROM LIABILITY FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH CAUSED BY NEGLIGENCE OR ANY
OTHER CAUSE.
___________________________________Name of Participant
X_________________________________ Parent/Guardian Signature (if under 18)