Unity of the Brethren 2011 Summer Camping Program Information and Registration Form 2011 Schedule Alpha Camp (ages 9&10) Discovery Conference (ages 13&14) June 12-14 (Sunday 3 PM to Tuesday 3PM) June 26-July 1 (Sun 4 PM to Fri 3 PM) Deadline / Registration Fee Deadline / Registration Fee By 4/15 - $200; By 5/1 - $250; By 5/15 - $275 By 4/15 - $300; By 5/1 - $350; By 5/15 - $375 Directors: John Paul & Jennifer Chervenka Directors: Todd & Amy Snelgrove Mike & Danna Dowling Mark Olsen Brett & Becky Norris Steve Gleinser Pioneer Conference (ages 11&12) Challenger Conference (ages 15&16) June 19-24 (Sun 4 PM to Fri 3 PM) July 10-15 (Sun 4 PM to Fri 3 PM) Deadline / Registration Fee Deadline / Registration Fee By 4/15 - $300; By 5/1 - $350; By 5/15 - $375 By 4/15 - $300; By 5/1 - $350; By 5/15 - $375 Directors: Don and Laurie Bagby Directors: Rev. Whitney Amos Arnold Motl Jennifer Chervenka Jennifer Chervenka Send All Registration Registrations must Glenn Fojtasek be postmarked Forms and Fees to: 2 Guinevere Place by deadline date!!!! The Woodlands, TX 77384 936-271-1761 The Hus School Encampment is a facility operated and supported by The Unity of the Brethren. The primary purpose of this facility is the advancement of the Kingdom of God on earth according to the commandment of Jesus Christ. The programs offered by the Encampment seek to challenge young people to respond positively to the good news of God's redeeming love; teach and encourage young people to become Christian leaders; and to provide a place of wholesome Christian recreation. Registration Importance of Registration - It is important that all young people send in their registration forms as early as possible so that programming plans may be completed. Registration deadlines are 3-tiered this year – Early Bird – April 15; Regular - May 1; Late - May 15. Completed Medical Release, Registration forms, fees, and copies of insurance cards should be sent to: Glenn Fojtasek 2 Guinevere Place The Woodlands, TX 77384 Checks should be made payable to: Hus School Food & Activity Account. If cancellation is made by the deadline, this fee will be refunded. If, however, cancellation is made after the deadline, or if campers simply do not come to the activity, the fee will not be returned. Medical Release Form Medical Services are available in Caldwell, four miles from the Encampment. We hope there is no need to use those services; but, in case it becomes necessary, the Medical Release form on the back of the Registration Form is a must. Please complete it in its entirety, and sign it, in order to ensure that medical services can be secured should they be required. Please also include a copy of your insurance card. Camp Discipline Procedures We hope all campers come with the right intentions, but every now and then an issue may arise that requires some disciplinary action on the part of the staff. Please be aware that the camp’s policy is as follows: 1st offense: conference with camper, write out agreement for rest of stay; 2nd offense: conference with camper and parents, review agreement from 1st conference, write out agreement for rest of stay; 3rd offense: conference with student reviewing actions and previous agreements, call parents to pick up camper, conference with parents. Cell Phone Policy Campers are asked to leave ALL electronic devices (radios, IPods, cell phones, etc.) at home. We realize some parents may prefer that their child have his/her cell phone in transit. Therefore, when phones are brought to the encampment they will be collected at check-in by the directors, locked up for the week, and returned to the camper at dismissal. What to Bring to Camp Bedding: 2 or 3 sheets, a blanket, a pillow, a pillow case, and an old rug or quilt to sit on outdoors. Personal Items: Toilet articles, towels, wash cloths Clothes: Regular "school type" clothes and sports wear such as jeans and shorts (modest), swim wear, if requested, should be one-piece or covered. Other Items: Bible, notebook, pencils, flashlight, raincoat or umbrella. Please Note: (1) All items brought to the camp should be clearly marked with the camper's name, and (2) No radios, CD/Tape players, Gameboys, DS, IPods, cell phones or other electronic devices will be allowed. Financial Assistance Financial assistance is available on a limited basis to those that would like to attend a conference or Hus School and would be unable to do so without financial aid. Please contact Glenn Fojtasek (address & telephone number listed) for further information. Directions to the Hus School Encampment From the intersection of U.S. Hwy. 21 and Texas Hwy. 36 in Caldwell, Texas, go south on Texas 36 approximately ½ mile. Turn east (left) on Farm Road 166. Stay on Farm Road 166 for 2 miles. Turn north (left) on County Road 225. Follow 225 approximately 0.8 miles to New Tabor Brethren Church, then past the church approximately 0.2 miles. Turn left at the Hus School Encampment directional sign (across the road from the SPJST Lodge Hall). Continue another 1 mile to the Hus School Encampment. Hus School Encampment Registration Form – 2011 All Registration Fees are Due with This Form Please fill in both pages of this form, detach and mail to Glenn Fojtasek, 2 Guinevere Place, The Woodlands, TX 77384. A check made out to “Hus School Food & Activity Account” is required for all Conferences Name of camper Telephone # Home Address (city) (State) (zip) Parents’ Names: ______________________________________________________________ Parents’ Email Camper’s e-mail Age as of September 1, 2011 School grade completed as of June 1, 2011 Date of Birth: Sex: Male Female Name of Home Church: _______________________Name of Pastor: _____________________ I plan to attend: (Check one) [age is by start of school/Sept. 1 after camp – ie: summer birthdays count] Alpha Camp (ages 9&10) Pioneer Conference (ages 11&12) June 12-14 (Sunday - Tuesday) June 19-24 Discovery Conference (ages 13&14) Challenger Conference (ages 15&16) June 26-July 1 July 10-15 Have you previously attended any of the camps/conferences at the Hus School Encampment? Yes No If yes, please list the camp and the year. _____________________ _________________________________________________________________________________________ T-shirt size (sometimes required for art/craft activities) Youth sizes: Medium Large Adult sizes: Small Medium Large Extra Lg I ( ) do, ( ) do not give my permission for my child’s contact information to be included in a camp roster that will go home with each camper. I ( ) do, ( ) do not give my permission for my child’s photo to be published on the Unity website, in the Brethren Journal, on a take home CD, camp scrapbook, etc. Parents’ signature _________________________________________ Date ____________ Please include a copy of the camper’s medical insurance card and the entire registration fee with this form. Hus School Encampment Health and Medical Release Form Name of camper Date of Birth: Age: Sex: Male Female Name of parent or guardian Home Address (city) (state) (zip) (telephone number) Business Address (city) (state) (zip) (telephone number) Mother’s Cell _________________________________ Father’s Cell ______________________________ If person named above is not available in the event of an emergency, notify: Name Relationship Telephone Name Relationship Telephone Name of personal physician Telephone Personal health insurance carrier Policy No. List medications to be taken during camp: List allergies to: Medications: Foods: Plants/insects: List any physical or behavioral conditions that may affect or limit full participation in Hus School Encampment activities: Immunizations: (last year given) vaccinated or had disease Measles Tetanus Mumps Diphtheria Rubella Polio Pertussis Chicken Pox I give permission for full participation in the Hus School Encampment Program, subject to limitations noted herein including my child’s inclusion in a group conference photo and I grant my permission for the group photo to be posted on the Unity of the Brethren’s website. In case of emergency, I understand every effort will be made to contact me. In the event I cannot be reached, I hereby give my permission to the directors or other adult leaders of the Hus School Encampment to secure the services of a licensed physician to provide proper treatment, including hospitalization, anesthesia, surgery, or injections of medication for my child. Date Signature of parent/guardian Please include a copy of the camper’s medical insurance card and the entire registration fee with this form.
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