CAMPER REGISTRATION by r16lFE

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									Mail this in with all registration/information forms, registration fee, and volunteer camp staff applications to:
Girls & Boys Camp, BCNE, 87 Lincoln St., Northborough, MA 01532


                           CAMPER PERSONAL INFORMATION FORM
Check Appropriate Camp
         Girls Camp at Farmington, July 9-14, 2012
         Boys Camp at Farmington, July 16-21, 2012
                      [Please carefully print all information except for your signature]

Camper’s Full Name

Age             Date of Birth

Grade completed (as of camp date)

Address

City                                            State                           Zip

Home Phone                                      Parent’s Work Phone

Your Church

Church Address

Church City                                                        State                Zip

Is camper attending camp with a church other than own?           Yes               No
If yes, write the name, city, and state of the church attending with:



Has camper ever made a public profession of faith in Jesus Christ as his or her Lord and Savior?
            Yes          No If yes, when?

I understand that campers are not to bring cell phones to camp, and are not permitted to receive or
make calls/texts while at camp.          (Initial)

My child and I agree to abide by the rules of the camp established by the camp director and the
campground owner. Should the need arise, after talking with me, the director may send my child home
at my expense in order to maintain camp discipline.

                                                        /                  /
Parent/Guardian Name [Please Print]                         / Date /           Signature



Emergency Contact and Telephone Number

Name of requested buddy
(Buddies must be in the same grade. No more than 2 per church per cabin unless there is an uneven number.
Buddies should request each other.)


                                                                                                                    Page 1
Mail this in with all registration/information forms, registration fee, and volunteer camp staff applications to:
Girls & Boys Camp, BCNE, 87 Lincoln St., Northborough, MA 01532

For Camp Staff Use:
Cabin assigned:
Counselors:
Camper’s Name:


              2012 SUMMER CAMP PERMISSION/INDEMNIFICATION FORM

Parents: This form must be filled out for each child attending camp. Staff will keep the forms with
them during the week. Campers will not be admitted to attend camp without this completed form.

                               has my permission to attend       Girls Camp or                         Boys Camp
at Farmington Conference Center, Farmington, ME, on the following dates
                               with the                                                                Church.

He/She has my permission to participate in recreation.                         [Initial]

He/She has my permission to swim.                      [Initial]

He/She has my permission to be transported for field trips away from the Farmington Conference
Center.           [Initial]

                      Photography Permission for Participant Attending Camp
On some occasions photography/video will be taken of participants as they participate in the activities at camp.
These photographs/video clips will only be used for promotion of Girls & Boys Camps, Farmington Conference
Center, and other Baptist Convention of New England Ministries. These promotions could be by way of
brochures, mailings, web page, video, CD to each participating church, special mailings. At no time will the
names of campers be in any of these promotions. Your signature gives us permission to use
photographs/videos taken at camp for the use of promotion as listed above.

Camper’s Name:
Signed:
            (Parent or Guardian)
Printed Name:                                                      Date_________________________
              (Parent or Guardian)

In case of medical emergency in which I cannot be reached, the adult leadership has my permission
to contact a physician to provide any necessary medical attention for the above-named child.
               [Initial]
In consideration of the opportunity for the above-named child to participate in the Camp, I hereby
agree to indemnify and defend the Baptist Convention of New England, the Maine Baptist
Association, the                           Church, as well as all Officers, Employees, Chaperones,
Representatives, and Volunteers thereof, from:
     All liability for any property damage by, personal injury to, or loss of consortium of the above-
       named child and
     All liability whatever arising from any acts or omissions of the above-named child while going
       to, during, and returning from the Camp.

Parent/Guardian Name
Parent/Guardian Signature                                                                  Date
                                                                                                                    Page 2
Mail this in with all registration/information forms, registration fee, and volunteer camp staff applications to:
Girls & Boys Camp, BCNE, 87 Lincoln St., Northborough, MA 01532

                                       Camp Medical Form – 2012


Name of the camper                                                               Age            Sex

Address
City_________________                                            State                          Zip

Emergency Contact                                                        Relationship
Emergency Telephone

Family Physician                                                Telephone

Insurance Company and Policy Number

Past Medical History
Asthma               Sinusitis                 Bronchitis                Hay Fever
Heart Trouble____ Diabetes____                 Dizziness____
Stomach Upset          Other                   Kidney Trouble

If your child has had head lice in the past school year please check your child’s hair. Please treat your child if
you see lice. Date of treatment_____

Allergies (List reactions: use additional sheet if needed.)
Food              Penicillin            Insect/Bites            Poison Sumac/Oak/Ivy

Previous Operations or serious illness

Special Dietary Needs

Childhood diseases: Chicken Pox             Measles           Mumps          Rubella            Cough
Other         Explain

Immunizations: Tetanus                  Polio Booster          Measles                  Mumps
Other         Explain

Current Medications, times taken and dosages (Specific form to be brought with camper to camp.)
      Medicine            Breakfast          Lunch            Dinner          Bedtime            Other




I give permission for this medicine to be given by the camp staff as prescribed by the physician.

Parent/Guardian Signature                                                               Date



                                                                                                                    Page 3
Mail this in with all registration/information forms, registration fee, and volunteer camp staff applications to:
Girls & Boys Camp, BCNE, 87 Lincoln St., Northborough, MA 01532

                                           2012 Medical Release
Camper’s Name:

Parent/Guardian/Staff Authorization
Initial each item and sign below:

This health history is correct and complete as far as I know.

I give permission for prescription medicine to be given by the camp staff (nurse) as prescribed

The person herein described has permission to engage in all camp activities except as noted.

I hereby give permission to the camp to provide routine health tests.

I agree to the release of any records necessary for treatment, referral, billing, or insurance purposes.

I give permission to the camp to arrange necessary related transportation for my child.

In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the
camp to secure and administer treatment, including hospitalization, for the camper named below.

I understand that the camp health personnel will care for minor injuries and pains according to the Camp
Medical Standard Orders Sheet. (These include but are not limited to: stomach aches, headaches, bug bites,
minor scrapes and scratches.)

Camper’s Name:

Signature:
               (Parent or Guardian)

Printed Name_____________________________________________ Date_                        _______________________
             (Parent or Guardian)




                                Registration Cost per Camper for 2012 Camps

                   Girls Camp at Farmington: Before June 20 - $155; After June 20 - $165

                   Boys Camp at Farmington: Before June 27 - $155; After June 27 - $165




                                                                                                                    Page 4
Mail this in with all registration/information forms, registration fee, and volunteer camp staff applications to:
Girls & Boys Camp, BCNE, 87 Lincoln St., Northborough, MA 01532




       Information for 2012 Camp Staff Training Track (T2)
    Who can be part of the Training Track? Girls completed 10th grade - 12th grade 10th
                       graders may apply to be on the Training Track
               Otherwise, they will be in the Chapel Girls as a regular camper

            When does this happen? During Girls Camp at Farmington - July 9-14, 2012

                                         What you can expect?
                                                     Fun
                                      Special activities for T2 Cabin
                                Responsibilities for various Camp Activities
                                    Using your Creativity and Talents

                                                  Self Discovery
                                                    Personality
                                                     Learning
                                                  Spiritual Gifts

                                               Spiritual Growth
                                            Interactive Bible Study
                                                  Quiet Time
                                                   Worship

                                                   Serving
                                              Camp Photography
                                     Serve Some Meals and/or Snacks
                                   Special Project for Younger Track Girls

                                              Leadership Skills
                                                Leading Games
                                             Leading Bible Study
                                            Handling Camper Issues

                                                 Plus Lots More!


                                                                                                                    Page 5
Mail this in with all registration/information forms, registration fee, and volunteer camp staff applications to:
Girls & Boys Camp, BCNE, 87 Lincoln St., Northborough, MA 01532
                            Your housing will be separate from the older track.




                         Application for Training Track (T2)
         (To be completed by camper and to be attached to the regular Camp Information Forms)


Name

Grade Completed                    Age                     # Years as Camper

Why do you want to be part of the Training Track?




       What do you hope to learn while part of this track?




       What does being a Christian mean to you?



                                                    Are you a Christian?
If yes, how do you know you are a Christian? (use another piece of paper if needed)




Read carefully and sign below if you agree and commit to the following:
I recognize that I will be a role model for the younger campers. Yes            No
I will participate as a role model worthy of emulation. Yes       No
I will participate fully and enthusiastically in activities. Yes        No
I will serve as asked gladly. Yes         No
I will give constructive feedback regarding the value of the various activities and training
provided. Yes                No
I will endeavor to learn, to play and to seek who God wants me to be. Yes             No

Signature                                                              Date
                                                                                                                    Page 6

								
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