WHAT TO BRING
PLEASE DO NOT BRING
_____ Light Jacket or Sweatshirt
_____ Sturdy footwear for hikes
_____ Bug spray
_____ Daypack or Backpack for hikes
_____ 4-5 complete changes of clothes
_____ One-piece swim suit/towel
_____ Sleeping Bag
_____ Pillow
_____ 2 Water Bottles
_____ Personal hygiene supplies
_____ 3 pair hiking socks
_____ Pencil and Paper
_____ Bible, if you do not have one we can
give you a bible to keep.
Valuable jewelry, cash, candy or food, hatchets, knives, any
and all electronic music, games and phones, tobacco products,
or any other item not listed here which would not be conducive
to a Christian camp atmosphere.
Globe Creek Camp is not responsible for loss or
damage of personal property
**Clothing and gear need to be marked with camper’s
name**
Remember, a well-prepared camper is a happy camper!
TRANSPORTATION: Parents are responsible for transportation to
and from Globe Creek Camp.
ARRIVAL TIME AT CAMP:
DEPARTURE TIME FROM CAMP:
10:00 AM
4:00 PM
LOCATION: Camp is located about one hour north of Fairbanks at
37 Mile Elliott Highway, From Fairbanks, take the New Steese
Highway to Fox. Do not turn as you go through Fox. As you pass the
weigh station you will be on the Elliot Highway (2 North) Mile 0.
Just before Mile Marker 37, turn left off the highway to the camp. If
you cross Globe Creek Bridge you have gone too far.
CAMP ACTIVITIES:
925 Foot Zip Line
Overnight Adventure Hikes
Nature hike to Grapefruit Rocks
Obstacle Course/Team Building
Inner Tubing on Globe Creek
Fun Field Games
Crafts
Evening camp fires on Globe Creek
Bible Teaching
Praise and Worship
CONTACT INFORMATION:
Camp Office Address:
Globe Creek Camp
1141 Acorn Circle
North Pole, AK 99705
Executive Director: Mike Dynes, (907) 888-8090
Registrar: Marsha, (907) 888-5709
For online payment and registration forms go to:
Website: www.globecreekcamp.com
or for more information
Email: [email protected]
Please call or email if you have any questions.
Globe Creek Camp Registration, Payment and Medical Form
Summer Adventure Camps 2015
July 11-14 Grades 7-10 Cost $225
July 16-19 Grades 3-6 Cost $225
Mail two-page Registration to:
Globe Creek Camp
1141 Acorn Circle,
North Pole, AK 99705
Or: Scan & email to: [email protected]
One Registration Form per Camper.
Please try to have registration complete no later than one week before start of camp.
CAMPER’S NAME:
____Male ____Female
______Grade next Fall
______Age
Parent/Guardian Names:
and
Legal Relationship:
and
Birth date: _____/_____/___________
Cell Phone:
Cell Phone:
Work Phone:
Work Phone:
Home Phone:
Email Address:
Mailing Address
School Camper Attends:
Church Affiliation, if any:
Payment Information:
Check Appropriate Camp:
$225.00 July 11-14
Grades 7-10________
$225.00 July 16-19
Grades 3-6______
Family Discounts
-$ _______Family Discount
Full price for oldest camper,
10% discount for 2nd camper,
20% discount for 3rd camper,
Etc.
_
______ $25 Zipline T-Shirt
______ $35 Zipline Hoodie
+ $_________ Full Camp Fee
+ $_________ Shirt Amount
= $_________ Total
- $_________ Minus Discount
= $_________ Total Amount
Method of Payment:
Cash___________ Check________#____________
Make checks payable to: “Globe Creek Camp”
PayPal_________ at: www.PayPal.com
Click on “Send” from the menu at the top of the PayPal window.
Key in our email “[email protected]”
Write in the Amount.
Health and Medical Questionnaire
CAMPER’S NAME:__________________________________________________
Non-Parent/Guardian Emergency Contact Information––To be used only if Parent/Guardian is unavailable
Name__________________________________________ Relationship to Camper__________________________
Home Phone:____________________ Cell Phone:____________________ Work Phone:____________________
Medical Insurance is not provided by Globe Creek Camp
Medical Insurance Policy Name:_____________________________ Policy Number or ID#:__________________
Name of Primary Physician:___________________________________
Physician’s Phone:_________________________ Name of Clinic Used:__________________________________
Medical History: Circle all questions yes or no:
Yes No Have you had an injury requiring medical attention in the past year?
Yes No Have you been hospitalized in the past year?
Yes No Are you currently taking any prescription or non‐prescription medications?
Yes No Do you have any allergies (food, pollen, medicine, stinging insects)?
Yes No Have you ever become ill from exercising?
Yes No Do you have asthma?
Yes No If yes, do you have an inhaler?
Yes No Do you have any heart conditions?
Yes No Do you have any medical conditions requiring treatment or medication?
Yes No Do you have any conditions, which may limit participation in camp activities?
Yes No Are you under a doctor's care?
If camper has problems with strenuous hikes of 2 hours or more get a Doctors approval for activity.
IF YOU ANSWERED YES to any of the above questions, please explain in the space provided below.
Especially make note of medication amounts and times for while your camper is at Globe Creek Camp.
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
If, in the judgment of any representative of Globe Creek Camp, the above camper should need immediate care and treatment
as a result of any injury or sickness, I do hereby request, authorize, and consent to such care and treatment as may be given
said camper by any physician, nurse or camp representative. I do hereby agree to indemnify and save harmless Globe Creek
Camp dba Alaska Wilderness Youth Camps, Inc. and/or hospital representatives from any claim by any person on account of
such care and treatment of said camper. If, between this date and the beginning of camp, if any illness or injury should occur
that may limit this camper's participation, I agree to notify the camp of such an illness or injury. I understand the risks and
dangers involved in outdoor summer/winter activities. I have read the list of activities, which includes the zip line and an
over-night off campus hike that my child will participate in while attending Globe Creek Camp. I give my child permission to
engage in those activities, except as noted above by my family physician or myself.
Yes ______No ______ I give GCC permission to use camp photos for promotional purposes.
Yes ______No ______ I give my child permission to ride the zip line.
I hereby state that, to the best of my knowledge, my answers to all questions are complete and correct.
I have instructed my child to follow camp rules.
Camper Signature:_________________________________________ Date: __________________________
Parent Signature:__________________________________________ Date:__________________________