Medical Information: Last Tetanus booster ____/____/_____ Known Allergies? Yes No If yes, please list? __________________________ ___________________________________________ ___________________________________________ All medications sent with your child MUST be in their ORIGINAL bottle/package with pharmacist’s instructions listed. List medications and time to be taken: ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ Campers Doctor: ___________________________ Phone: (___)________________________________ Insurance Company: ___________________________________________ Policy # ___________________________________________ Any camper activity restrictions? ___________________________________________ ___________________________________________ ___________________________________________ My signature certifies that the registrant (camper) is in good health and may participate in the activities of Camp Faith. Exceptions are listed. In case of medical emergency, when legal guardian cannot be reached, I authorize the Camp officials to secure appropriate medical personnel and/or treatment for, and to order injection, anesthesia, dentistry, or surgery for the camper named on this form. Should it become necessary for the camper to return home because of illness, or for any other reason, I will abide by Camp Faith’s decision (at my or the church’s own expense). I give my permission to use photos including the camper in camp publicity. My signature certifies that the camper will abide by the Camper’s Code of Conduct and all regulations governing personal conduct and the use of camp property and will participate fully in the camp program. Guardians Signature ____________________ Date: _____/_____/_____ Hebrews 11:6a But without faith it is impossible to please HIM. CAMP FAITH 321 Sugar Camp Rd. Shinnston, WV 26431 Phone: 304-629-8359 or 304-592-5756 Email: [email protected] www.campfaithinwv.com Camp Registration: $95 Registrations received before due date will receive a $20 discount. $75 payable to Camp Faith Registrations will be accepted as long as space is available. Please bring $5 to $10 for snack shack. Check In Registration Starts: Monday at 10:00am Check Out: Friday at 10:00 am for Jr. Camp Junior Camp (Ages 7-12) June 15-19, 2015 Registration due by May 25, 2015. Speaker for Junior Camp To Be Announced Camper Code of Conduct - Medications are NOT to be kept by any campers and/or counselors. ANY AND ALL medications either prescription or otherwise must be turned in to camp senior staff upon arrival. - Physical contact between male and female campers is NOT permitted and strictly forbidden. - Camp Faith reserves the right to ask ANY camper to change attire if it is deemed inappropriate. - No inappropriate advertisements on clothing please. LADIES: - Dress clothes for chapel: modest loose fitting skirts, dresses covering the knee, and tops. - Activity clothes: loose fitting shorts covering the knee and t- shirt. - Modest sleepwear covering the knee. - Swimwear: One piece swimsuit with cover up/robe or dark loose fitting shorts covering the knee with a dark t-shirt. GENTLEMEN: - Dress clothes for chapel: collared shirt and pants. - Activity clothes: loose fitting pants or shorts covering the knee and t-shirt. - Swimwear: swim trunks covering the knee and dark t-shirt. What to Bring to Camp: Teen Camp (Ages 12-18) July 13-18, 2015 Registration due by June 22, 2015. Pastor Burton Gates Liberty Baptist Church Philadelphia, PA Music: • The Vaughan’s • Blessed Point KJV Bible, notebook, pen, pillow, sleeping bag or bedding for twin bed, washcloths, shower towel, pool towel, toiletries, dress clothes for chapel, activity clothes, comfortable pair of tennis shoes, spending money, flashlight, sunscreen, and yourself! CAMPER REGISTRATION FORM Registration for Jr. Camp is due May 25, 2015 Teen Camp is due June 22, 2015. Please return this form completed with registration fee. Make Checks payable to Camp Faith. Camp Faith 321 Sugar Camp Rd Shinnston, WV 26431 Phone: 304-592-5756 Camper Information: Name______________________Sex M or F Birthdate ____/____/____ Grade: _________ Guardian:____________________________ Address:_____________________________ City:_______________State_____Zip______ Home Phone (____)____________________ Parent’s Cell Phone (____)_______________ Email:_______________________________ Emergency Contact: (if parent can’t be reached) Name:___________________________________ Relationship to Camper:_____________________ Home Phone (____)________________________ Work Phone(____)______________________________ Cell Phone (____)__________________________ What NOT to Bring to Camp: - Electronic media devices of ANY kind, including cell phones! - Tobacco, alcoholic beverages, or controlled substances. - TVs, magazines, or any other questionable reading Speakers: material. - Knives• or weapons of ANY kind. Pastor Charles V. Madaus - Fireworks, lighters or matches. • Pastor Dan Vaughan - Clothing with inappropriate advertisements, sleeveless or tight fitting shirts. - No food or drinks should be brought to camp. We encourage parents to send mail to campers. Email:____________________________________ Church Information: Church Name:___________________________________ Pastors Name:_____________________________ City:________________________State_________ Continued on Reverse side
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