How Registration Works 1. Collect all Camper & Group Leader Forms ! ! ! ! ! ! Camp Date_______________ Camper Registration Form Church City: No insurance at this time. Health Insurance Co.:___________________________________ Group #__________________ Policy # __________________ Camper’s Doctor:______________________________________ City:________________________ Phone:__________________ T-Shirt Size: ___S ____M ___L ____XL ____XXL ___XXXL ! STUDENT INFORMATION Campers Name:______________________________ Male Grade:_______ Female ! Camp Cedar Crest - to be completed by parent or legal guardian - Registration Deadline: Church Name: ! ! ! Pacific Coast & Valleys District Youth CAMPER'S MEDICAL HISTORY Registration Fee: ! Age:______ DOB ____/_____/_________ Address:____________________________________ City:___________________________Zip:__________ Home Phone:________________________________ Cell Phone:__________________________________ PARENT/GUARDIAN INFORMATION Parent/Guardian:______________________________ Work Phone:_________________________________ Cell Phone:__________________________________ 1. Does the camper suffer from any medical, physical, emotional or behavioral conditions which might affect his/her safety while at the camp? (e.g. claustrophobia, vertigo, asthma, heart condition, diabetes, epilepsy, etc.) Yes No If yes, please specify: ________________________________ __________________________________________________ 2. Is the camper undergoing any form of medical or psychological treatment, including medication? Yes No If yes, please specify: ________________________________ _________________________________________________ -Cost information is customizable -PDF documents downloadable at www.pcvnextgen.com -Make Sure Everything is filled out Is camper on prescription medication? Yes No If so, please list exactly what and when it is to be taken: ________________________________________________ ________________________________________________ (Please attach additional information as needed) 3. To the best of your knowledge, has the camper been in contact with any infectious or contagious diseases, or suffered from anything in the last four weeks that might be or become infections or contagious? Yes No If yes, please specify:________________________________ _________________________________________________ EMERGENCY CONTACT INFORMATION Same as above. Emergency Contact:___________________________ Relation to Camper____________________________ Phone:______________________________________ MAKE SURE BOTH SIDES OF SUMMER CAMP 2008 T H I S F O R M A R E C O M P L ET E LY FILLED OUT ! ! 4. Is the camper allergic to any food or any medications? Yes No If YES please specify: __________________________________ 5. Date of last tetanus shot ____/_____/_________ 6. Do you give permission for staff to give the camper the following: Acetaminophen: Yes No Ibuprofen: Yes No 7. Special dietary requirements: _________________________ ! ! Camper Release Form • ! ! ! ! ! ! We need all signatures on all forms! Student Signature Parent Activity Signature Pastor Signature Group Leader Form • We need all signatures on all GL forms! Group Leader Declaration Pastor Checkbox for background check (background checks are necessary for every GL) Pastor Signature Attention If any signatures are blank (i.e. not signed) students or Group leaders will not be able to stay at camp. 1 How Registration Works Page 2 2. Fill Out Camper Worksheet • • • • • This is downloadable as a PDF document. Please observe the late registration cost difference for every student or leader that is received after due date. All information boxes that apply need to be filled out. Both STUDENT and GROUP LEADER info will be filled out on this form. Make copies, for your records and send the original to the District Office with the other required forms. Camper worksheet 3. Fill Out Financial Worksheet Financial Worksheet and Registration Information Summer Camps 2012 Keep the original of the worksheet for your records and mail a copy and church check to: • • Pacific Coast and Valleys District 3353 Old Canejo Road Newbury Park, CA 91320 Registration due Friday, July 13 For Both Camps! July 20-24 camp and July 24-28 camp Camper Cost: GL Cost: By Deadline $150 $100 After Deadline $170 $120 • For more registration forms, go to www.pcvnextgen.com • Please make a new worksheet if additional students or leaders register. • Pacific Coast and Valleys Camps observe at least a 1:6 Leader to student ratio (per gender). • Cancellation Policy: Any cancelations made within one week of camp are subject to a $50 cancellation fee unless an exchange is being made between two students of the same gender and age group (i.e. middle school student for middle school student). • • This is downloadable as a PDF document You will fill this form out and MAIL it along with your PAYMENT to be IN the office by the due date. Any additional students or leaders that sign up after the deadline, please fill out a NEW FORM and mail it. Please observe the late registration cost difference for every student or leader that is received after due date. You will mail the actual registration forms along with this form. (Make Copies For Yourself) 4. Registration Forms • ...Are to be completed entirely, have required signatures and are to be mailed to the District Office along with the required forms above and your payment. • Make copies of these registration forms • The original signed form is to be mailed to the District Office. • Keep 1 copy for your records as you travel. Original! Copy for You 2 How Registration Works Page 3 5. Additions / Cancellations • Camper worksheet • • • Use the Camper Worksheet and DATE it every time you have any ADDITIONS or CANCELLATIONS after you have MAILED your first Camper Worksheet document. Any cancellations made within one week before the camp date are subject to a $50 cancellation fee unless an exchange is being made between two students of the same gender and age group (i.e. middle school student for middle school student). Refunds after the completion of the camp are considered on a case-by-case basis. The District will only refund a church NOT an individual. The church refunds the individual and then requests a refund from the District Office 6. Collect All Student Medication • • Before arriving at camp, collect all student medication, put it in a ZIPLOC bag and label it with the following information: • Student’s First and Last Name • Church Name • Names of the medications • The schedule of WHEN they are to be taken. You will present all medication when registering at camp 3 Camp Information Additional Information Here are just a few more details we want to communicate: 1. We have a 1 to 6 Group Leader to Student ratio. If you want to bring extra Group Leaders, they are welcome to come, provided we have space available. 2. Camp Cedar Crest’s Address is: 1. 33325 Green Valley Lake Rd. Running Springs, CA 92382 Phone: 909-867-7363 2. Driving Directions: Take the San Bernardino Freeway (I-10) east to Redlands. Go North on Junction 30 to the 330 or the 210 to the 330 which goes up the mountain to Running Springs where it will become Highway 18 to Big Bear. Go approximately 2.5 miles pass Running Springs, turn left on Green Valley Lake Rd. Go one mile to Camp Cedar Crest Rd., turn right. Take road 1/4 mile to parking lot. Please remember to check with the Highway Patrol to make sure roads are open. 3. Here is the map to Camp Cedar Crest: 210 Fwy 4