STUDENT FORM Camper Registration 2010

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STUDENT FORM Camper Registration 2010 Powered By Docstoc
					Camper Information:
Last Name ________________________________ First ___________________
DOB ___________ Circle: Male or Female Grade (fall 2010) _____________
Church NORTHSIDE CHRISTIAN CHURCH           Group Leader ____________________                                         Summer Camp 2010
Insurance __________________________________ Tetanus Current Y or N
List any Health, Physical or Dietary Restrictions the Camp Staff/Nurse should be
                                                                                                                    Camper Registration Form
aware of: _______________________________________________________
________________________________ Allergies _________________________               Hidden? Parables of the Kingdom recorded by Matthew
List All Medications Routinely Taken. Prescription & Non-Prescription:
Med & Dosage ______________________________ Reason _______________
Med & Dosage ______________________________ Reason _______________                      Session         Date(s)        Entering      Deadline        NCC
Med & Dosage ______________________________ Reason _______________                                                      Grade         Date           Cost
May be given Over-the-Counter medication as deemed necessary by the camp
                                                                                       Kindergarten       July 17     Kindergarten      June 9        $20
nurse, according to protocol. Yes or No
Circle Camp Session Attending:                                                        First Chance 1 June 21 - 22 Grades 1 - 2         May 12         $45

Kindergarten - $20      First Chance 1 - $45      Middler 1 - $65                        Middler 1     June 23 - 25 Grades 3 - 4       May 12         $65

Junior 3 - $95          Jr. High 1 - $140         Sr. High 1 - $140                      Junior 3      July 21 - 24   Grades 5 - 6      June 9        $95

                                                                                        Jr. High 1      June 27 -     Grades 7 - 8     May 12         $140
                                                                                                          July 2

                     To Complete Your Registration                                      Sr. High 1     June 6 - 11 Grades 9 - 12       May 12         $140

 •    Turn in your form and check made out to Northside Christian Church
                                                                                          A $25 late fee will be assessed if you register after the
      at the in the drop box at the camp table in the lobby. This helps us know
                                                                                                                 deadline date.
      who is coming so we may plan for transportation and ensure we have
                                                                                         NCC price is for all regular attenders of Northside and any
      recruited adequate numbers of adult volunteers to attend with the camp-
                                                                                                 friends who don’t attend another church.
      ers.
 •    Consider attending camp with your child(ren). Pick up a adult/teen
                                                                                         If you register on or before Camp Kick
      volunteer form at the camp table desk to attend.
                                                                                          Off (April 25) you will receive a FREE
 •    Scholarships are available. Pick up scholarship application forms at the
                                                                                                Camp T-Shirt ($10 value).
      camp table in the lobby.
 •    If you would like to send your camper a letter during their week of camp,
      the camp address is below.                                                                        www.northsidechristianchurch.net
                                                                                                                 417-833-1861
                                                                                   For questions about Jr/Sr High camp, contact Phyllis@northsidechristianchurch.net
                             Camper Name                                            For questions about children’s camp, contact Helen@northsidechristianchurch.net
                                                                                                              www.maranathabiblecamp.org
                            Session of Camp
                                                                                                  417-535-6085 or campinfo@maranathabiblecamp.org
                       c/o Maranatha Bible Camp
                          18131 Highway WW
                          Everton, MO 65646
                                                                                                       “I will open my mouth in parables,
                                                                                         I will utter things hidden since the creation of the world.”
MBC 2010 Camper Registration                                                                Camper Information:
                                                                                            Last Name ________________________________ First ___________________
Family Information:                                                                         DOB ___________ Circle: Male or Female Grade (fall 2010) _____________
      Please List Parent/Guardian(s) With Whom Camper Resides
                                                                                            Church NORTHSIDE CHRISTIAN CHURCH           Group Leader ____________________
Father Last Name ___________________________ First _________________
                                                                                            Insurance __________________________________ Tetanus Current Y or N
Home Phone ______________________ Cell ________________________                             List any Health, Physical or Dietary Restrictions the Camp Staff/Nurse should be
Work Phone ________________ Email _________________________________                         aware of: _______________________________________________________
Mother Last Name _______________________ First _____________________                        ________________________________ Allergies _________________________
                                                                                            List All Medications Routinely Taken. Prescription & Non-Prescription:
Cell _____________ Work Phone ____________ Email ____________________
                                                                                            Med & Dosage ______________________________ Reason _______________
Address __________________________________________________________
                                                                                            Med & Dosage ______________________________ Reason _______________
City _______________________________ State ___________ Zip __________                       Med & Dosage ______________________________ Reason _______________
Other emergency contact ______________________ Phone ________________                       May be given Over-the-Counter medication as deemed necessary by the camp
Relationship to Camper(s) ___________________________________________                       nurse, according to protocol. Yes or No
                                                                                            Circle Camp Session Attending:
         Important Information that Requires Parent’s Signature                             Kindergarten - $20      First Chance 1 - $45      Middler 1 - $65

“To the best of my knowledge my child(ren) is/are physically and emotionally able to
take part in the camp program. In the event of a medical emergency, I give permission       Junior 3 - $95          Jr. High 1 - $140         Sr. High 1 - $140
to the volunteer medical person selected by the camp management to do whatever is
necessary for the health of my child(ren) as named on this card. I hereby release the
camp from any responsibility other than normal supervision and care. In case of an acci-    Camper Information:
dent, I will not hold Maranatha Bible Camp or its staff members, management, or officers    Last Name ________________________________ First ___________________
liable. I have reviewed this form and certify that all appropriate medical information is
                                                                                            DOB ___________ Circle: Male or Female Grade (fall 2010) _____________
included.”     Parents Initials ______________
                                                                                            Church NORTHSIDE CHRISTIAN CHURCH           Group Leader ____________________
I understand that my child(ren) attending a Junior High or High School camp may be          Insurance __________________________________ Tetanus Current Y or N
offered an opportunity for offsite recreation such as: 1. Inner tubing on Turnback Creek
and that MBC requires that a life vest be worn regardless of my child(ren)’s swimming       List any Health, Physical or Dietary Restrictions the Camp Staff/Nurse should be
ability; or 2. Archery & Skeet Shooting at the Bois D’arc Conservation Center under the     aware of: _______________________________________________________
direct supervision of trained Conservation Department Personnel. Campers attending          ________________________________ Allergies _________________________
Horse Camp will be transported to Sac River Stables for training and riding sessions.
MBC staff accompanies campers on all offsite events.                  Parents Initials      List All Medications Routinely Taken. Prescription & Non-Prescription:
______________                                                                              Med & Dosage ______________________________ Reason _______________

I recognize that this is a Christian camp, that the Bible will be studied, and that camp
                                                                                            Med & Dosage ______________________________ Reason _______________
conduct will be expected that is consistent with Christian Values. I also give my permis-   Med & Dosage ______________________________ Reason _______________
sion for any appropriate photographs/videos to be used for future Maranatha Bible Camp      May be given Over-the-Counter medication as deemed necessary by the camp
promotional purposes.     Parents Initials ______________
                                                                                            nurse, according to protocol. Yes or No
                                                                                            Circle Camp Session Attending:
Signed ______________________________ Date _______________
                                                                                            Kindergarten - $20      First Chance 1 - $45      Middler 1 - $65

        Please fill out one Camper Information Box for each child attending.
                                                                                            Junior 3 - $95          Jr. High 1 - $140         Sr. High 1 - $140
                 Attach a sheet with additional information as needed.

				
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