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Tar Hollow Christian Adventure Camp Sidney First United Methodist Church 230 East Poplar Street Sidney, Ohio 45365 Non-Profit Org U.S. POSTAGE PAID Sidney, Ohio Permit No. 158 CAMP INFORMATION ENCLOSED Tar Hollow Christian Adventure Camp Camp Packet Tar Hollow Christian Adventure Camp Sidney First United Methodist Church 230 E. Poplar St. Sidney, Ohio 45365 (937) 492-9136 Fax (937)492-1409 It's that time for all of those entering grade 7 through Graduates to prepare for another spirit-filled th th week at Tar Hollow Christian Adventure Camp, August 8 - August 15 , 2009. The cost of Camp will be: $125.00 for all youth The above camp fees include a camp T-shirt. *In the case of MORE THAN TWO Campers from ONE IMMEDIATE FAMILY: The FIRST TWO pay FULL PRICE, and the OTHERS pay HALF PRICE. *Make checks payable to: TAR HOLLOW CHRISTIAN ADVENTURE CAMP. . For your Registration to be complete, you must return ALL of the following to the Church Office: 1. Registration Form - SIGNED by Parents and Camper. 2. Medical Form - COMPLETED by Parents, SIGNED and NOTARIZED. 3. Camp Fee - IN FULL. 4. T-Shirt Form DEADLINE for registration is July 25th, 2009. When an age group is filled, we will establish a waiting list. Registrations will be processed according to the DATE RECEIVED. *Space is always limited, so please return completed forms AS SOON AS POSSIBLE.. No one will be accepted after July 25th, 2009 **Registration Form will be returned if incomplete.** *Full refunds will be given until July 25th . PARENTS AND CAMPERS please read the enclosed Tar Hollow Rules. Signing the application is an agreement to follow the rules. Any violation of the Camp Rules will be subject to one or more of the following consequences: Extra Camp duties as assigned by the Director. Call home to Parents. Being sent home. Not permitted to return to Camp. Because of past problems with cell phones, camera phones, MP3 players, walkie talkies, radios, etc., do not bring these items to camp. Any of the above being used for any reason will be confiscated and returned at the end of camp. Tar Hollow will not be responsible for items confiscated. For ALL FIRST-TIME CAMPERS and THEIR PARENTS, we strongly recommend that you attend a th FIRST-TIME CAMPER MEETING ----- SUNDAY, JULY 26 , 2009 at 4:00 p.m. in New Fellowship Hall of the Sidney First United Methodist Church, 230 E. Poplar St., Sidney. (*This meeting will answer questions, as well as make the transition easier for the First-Time Camper.) st Cabins are formed on the basis of: Age, Grade and the desire to encourage new friendships. **It CANNOT BE GUARANTEED that Campers from the same Church will be in the same cabin. For more Registration Forms or questions, please call: Chuck Fridley (937) 394-7357 Or Sidney First United Methodist Church at (937) 492-9136. CHECK LIST: Completed and Signed Application Completed and Signed Medical Form Complete all of the Completed T-Shirt Form Medical Form Notarized For Office Use Only: Date Amt Ck Csh TAR HOLLOW CHRISTIAN ADVENTURE CAMP REGISTRATION FORM (This form must be turned in to the Church Office along with the Medical Form, T-Shirt Form, and Camp Fee.) CAMPER Name: Address: City: E-Mail Address: Date of Birth: (Please Print) Male: Phone: ( State: ) Zip: Female: Age: Grade Entering: ** Please check if you will be a First-Year Camper CHURCH INFORMATION Name of Church: Address: City: District: State: Pastor: Zip: For Campers: I have read and understand the description of the Camp for which I am registered and agree to participate fully in the program, obey rules and regulations and to remember that we desire to exemplify Christ in every way, which includes our conduct, our behavior and our dress. Therefore, we trust that each of you will conduct yourselves and dress in such a manner “THAT WOULD NOT ALLOW SOMEONE TO STUMBLE” (Romans 14:21) Camper's Signature For Parents/Guardians: I have read the description of and rules for the event for which my child is registering and understand the nature of the program. I grant permission for my child to participate in all Camp activities. Parent's/Guardian's Signature Camp Fees Amount Paid For Registration: Additional Donation (If Desired): Short Sleeve T-Shirt: Additional Shirts (If desired): Total: ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FREE SCHOLARSHIP APPLICATION (If Desired) Name of Camper: Complete Address: Reason Scholarship is needed: Amount Needed: THIS IS IMPORTANT ~ PLEASE READ!! MEDICAL INFORMATION COVER LETTER Dear Parent or Guardian: In the event of injury or illness to an individual while attending Tar Hollow Christian Adventure Camp, it is important that we receive a complete and accurate medical history on each person attending. Please provide the information requested on the attached "MEDICAL INFORMATION FORM." IT IS ESSENTIAL THAT WE HAVE THE DATE OF THE CAMPER'S LAST TETANUS INJECTION! If the camper does NOT have an up-to-date tetanus injection, we strongly urge you to obtain one prior to attending camp. All the information is treated confidentially and will only be released to medical personnel or other camp staff as required, ONLY IN THE EVENT OF AN EMERGENCY SITUATION. For the protection of the campers and staff, ALL prescription medications as well as over-the-counter antihistamines, diet pills, liquid cough and cold medicines, WILL BE DEPOSITED WITH THE CAMP MEDICAL PERSONNEL FOR THE DURATION OF THE CAMP. Exceptions will be made in the case of EMERGENCY heart or asthma medications or similar situations. Required medications will be distributed appropriately by the medical staff as regularly scheduled. YOU MUST FILL OUT THE SCHEDULE PORTION OF THE MEDICAL INFORMATION FORM TO ENSURE PROPER TIMING. "As needed" or "In case of" medications will be made available upon camper's request from the medical staff. PLEASE LEAVE ALL MEDICATIONS, BOTH PRESCRIPTION AND OVER-THE-COUNTER, IN THEIR ORIGINAL CONTAINER, AND MARK THEM CLEARLY WITH THE FULL NAME OF THE CAMPER FOR WHOM THEY ARE INTENDED. All unused portions will be returned to the Camper at the end of camp. NO camper will be permitted to attend this camp without the "Medical Information Form" being completed, signed by the parent or guardian, notarized and on file with the camp staff along with your application! THIS IS AN ABSOLUTE REQUIREMENT! If you have any questions or concerns, please contact the camp staff through the Sidney First United Methodist Church at (937) 492-9136 as soon as possible. Thank you for your cooperation in this matter. Confidential Medical Information Form FULL NAME COMPLETE ADDRESS HOME PHONE ( ) DATE OF BIRTH / / SOCIAL SECURITY # ALLERGIES: Please give specific information, including type of reaction, as to any allergic conditions, including medication, insect bites, animals, food, or other. TETANUS DATE OF LAST BOOSTER: MEDICAL HISTORY: Please circle any condition that is chronic, is currently being treated, or has occurred in the last year. On the right, please give further information on the condition including treatment and/or medication. All Rx medications must be listed along with the condition for which they are prescribed. All Rx medications must be sent as dispensed by a Pharmacy, with the Pharmacy label intact. All Rx medications are to be given to the Medical Staff at the beginning of Camp. The Medical Staff will be responsible for dispensing such medications as ordered by a Physician. It is illegal for us to dispense Prescription Medication without a valid Prescription. Any remaining Medications will be returned to the Camper, Parent or responsible Adult from the Church on the last day of Camp. Please list any Prescription the Camper is taking on a regular basis: EXPLANATION 1. EYE / VISION 2. SEIZURES 3. HEAD / SPINAL INJURY 4. HEADACHES 5. FAINTING / DIZZINESS 6. CONGENITAL CONDITIONS 7. SINUS / HAY FEVER 8. ASTHMA / WHEEZING 9. OTHER RESPIRATORY 10. EAR / NOSE / THROAT 11. HEART 12. DIABETES 13. LOW BLOOD SUGAR 14. OTHER BLOOD DISORDERS 15. HEPATITIS 16. ULCERS / STOMACH DISORDERS 17. KIDNEY / BOWEL DISORDERS 18. DENTAL 19. FRACTURES / SPRAINS 20. OTHER ORTHOPEDIC 21. ARTHRITIS 22. EMOTIONAL / BEHAVIORAL 23. EATING RESTRICTIONS 24. SKIN / DERMATITIS 25. OTHER MEDICATION NAMES DOSAGE OVER THE COUNTER MEDICATION: This child normally receives at home and I give my permission to the Camp Medical Staff to dispense as indicated the following Non-Prescription Medication (Generics may be used). Please indicate by drawing a circle around approved medications. TYLENOL ADVIL SUDAFED BENADRYL COUGH / COLD IMMODIUM ANTACID CALAMINE LOTION SOLARCAINE/BURN GEL ANTIBIOTIC OINTMENT HYDROCORTISONE CREAM ============================================================================================ NO CHILD WILL BE PERMITTED TO ATTEND CAMP WITHOUT THIS FORM ON FILE. MEDICAL HISTORY INFORMATION WILL BE KEPT CONFIDENTIAL BY THE CAMP MEDICAL AND ADMINISTRATIVE STAFF, AND SHARED ONLY TO PROVIDE NECESSARY CARE FOR CAMPERS. ========================================================================================================= Revised 4/15/01 PARENTS/GUARDIANS: (PLEASE PRINT) NAME COMPLETE HOME ADDRESS WORK LOCATION WORK ADDRESS NAME COMPLETE HOME ADDRESS WORK LOCATION WORK ADDRESS WORK PHONE ( ) HOME PHONE ( ) WORK PHONE ( ) HOME PHONE ( ) GRANDPARENTS OR OTHER CLOSE RELATIVE: NAME COMPLETE HOME ADDRESS WORK LOCATION WORK ADDRESS WORK PHONE ( ) HOME PHONE ( ) MEDICAL INSURANCE: NAME OF COMPANY ADDRESS OF COMPANY PHONE NUMBER: FILED IN THE NAME POLICYHOLDER DATE OF BIRTH: POLICYHOLDER SOCIAL SECURITY NUMBER POLICY NUMBER IF POLICYHOLDER IS DIFFERENT FROM PARENT/GUARDIAN, PLEASE ADD THE FOLLOWING: HOME ADDRESS WORK NAME AND ADDRESS HOME PHONE ( WORK PHONE ( ) ) FAMILY DOCTOR OFFICE ADDRESS OFFICE PHONE ( ) ) ALTERNATE PHONE ( SPECIALIST OFFICE ADDRESS OFFICE PHONE ( ) ) ALTERNATE PHONE ( DENTIST OFFICE ADDRESS OFFICE PHONE ( ) ) ALTERNATE PHONE ( PERMISSION TO TREAT NO CHILD WILL BE PERMITTED TO ATTEND CAMP WITHOUT THIS SIGNED AND NOTARIZED FORM ON FILE. I understand that the Camp Nurse or other qualified Medical Personnel will administer any necessary first-aid and/or other over-the-counter medicines for any minor injuries or illnesses that, if a serious injury or illness should occur, emergency medical care may be administered by qualified Camp Personnel and that, if any further medical treatment is deemed necessary, it will be obtained at the nearest Hospital Emergency Room as soon as possible. I further understand that, in the event of a serious injury or illness, every possible effort will be made to contact me at the earliest possible time. However, if time does not permit or if circumstances do not allow for this contact, I hereby give my permission to qualified Camp Personnel to provide emergency treatment and for the Attending Physician at the Hospital Emergency Room to provide emergency treatment or surgery as he deems necessary. This permission is in effect from the time the Camper enters the Campground area and becomes subject to Camp jurisdiction until the time he/she leaves the Campground area and is no longer subject to the Camp jurisdiction. NO CHILD WILL BE PERMITTED TO ATTEND THIS CAMP WITHOUT THIS FORM BEING SIGNED BY HIS/HER PARENT/GUARDIAN AND THIS FORM BEING ON FILE WITH THE CAMP STAFF BEFORE 10:00 A.M. ON THE DAY CAMP IS SCHEDULED TO BEGIN. My signature here acknowledges that I have read, understand, and consent to the above condition listed both on this form and the Cover Letter as well, and that all information is as complete and as accurate as is possible, to the best of my knowledge. I ALSO UNDERSTAND THAT NO CHILD WILL BE PERMITTED TO ATTEND THIS CAMP WITHOUT THIS FORM BEING SIGNED BY THE PARENT/GUARDIAN AND THIS FORM BEING ON FILE WITH THE CAMP STAFF BEFORE 10:00 A.M. ON THE DAY CAMP IS SCHEDULED TO BEGIN. _____________________________________________________________ SIGNATURE OF PARENT/GUARDIAN DATE ______________________________________________________________ SIGNATURE OF WITNESS TO ABOVE DATE --COMPLETE BOTH SIDES— NOTARIZATION CAMPER RULES Friends and family are not permitted to visit the camp during the week. Attend and report to meals and special events on time. Help your counselor by observing the camp schedule, especially lights out. Writing home is encouraged at camp, mailbox is in the office. Have clean bodies and clothes, report to the nurses’ station for first aid treatment. Swim only at swim periods and then only in the swimming area. No one can go to the lake or waterfront area unless on the schedule or at extra time by special permission from the Waterfront Director. When using the recreational equipment, boats, canoes. Care for them respectfully and RETURN them to their proper place when finished. At meals stay seated in the lodge until everyone is dismissed. Report for hopper duty on time, including Counselors, NO BATHING SUITS AT THE TABLE OR CLASSES. Keep cabin clean and in order, including the grounds around the cabin NO SMOKING IS PERMITTED FOR ANYONE UNDER 18, Adults 18 and over are permitted to smoke only at the designated time and area. Campers shall not be on other hills or in other cabins without authorization. Boys are not to be on the hill where there are girls’ cabins and vice-versa. Any singing etc. must be done from no lower then the closest cabin to the lodge. Camper are not permitted on the hills without permission except during assigned times. Do not go up the hill after friendship circle without your counselor. Cabin Devotions should be done nightly before any other in cabin activities Camp activities should involve all the cabin members including the counselors. Put your name on your camp book and any other personal belongings, you are responsible for them. Try something during the day to feel the presents of God- LET GO AND LET GOD! All campers are expected to attend camp for the full week, unless some unanticipated emergency occurs. Exceptions may only be made by the camp director. DISCUSSION ON THESE MATERS MUST BE HANDLED PRIOR TO CAMP. There will be no driving on the hills, to the Green Cathedral, to the dam, etc. at any time, unless deemed necessary by the camp director. Because of past problems with cell phones, camera phones, MP3 players, walkie talkies, radios, etc., do not bring these items to camp. Any of the above being used for any reason will be confiscated and returned at the end of camp. Any camper leaving the camp without authorization may be sent home immediately. 2009 LOGO SHIRT PRE-ORDER FORM SHORT SLEEVE T-SHIRT INCLUDED IN PRICE OF CAMP (Circle one) Short Sleeve T-shirt S M L XL XXL XXXL FREE Long Sleeve T-Shirt S M L XL XXL $14.00 9oz SWEAT SHIRT S M L XL XXL XXXL $19.00 9 oz HOODIE S M L (Choose color below for Hoodies Only) Ash Grey Red Gold Purple XL XXL XXXL $26.00 Burnt Orange Royal PLEASE RETURN: This Form and the Money for your order along with your registration Name: Phone Number: Age: ARTICLES TO TAKE TO CAMP 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. Camp clothes for daytime Warmer clothes for evening. (Camp can be messy - do not bring your best clothes.) Raincoat Heavy sweater Jacket or coat Plenty of blankets or sleeping bag Sheets, pillow, pillowcase Towels and wash cloths Toiletries - soap, toothbrush, toothpaste, comb, etc., as needed Bathing suit and beach towel. Your BIBLE - we provide a Camp Book and a pencil. Flashlight and extra batteries. Spending money for use at concession stand and for camp picture (which we estimate at $7.00 - Photographer sets price each year.) DO NOT BRING TOO MUCH MONEY!! Any material you want for your Cabin Worship Center. NO CANDLES ARE PERMITTED. Camera and film Musical instruments you can play plus sheet music if desired Two dozen cookies (preferably homemade) per family (Please put in tins or heavy containers to assure freshness). 14. 15. 16. 17. *Cookies may go in the truck, but if you bring them yourself, please bring them to the Camp Kitchen as soon as you arrive. -----------------------------------------------------------------------------------------------------------------------------------------CAMP REMINDERS *First-time to Tar Hollow Camper Meeting - Will be held here at Sidney First United Methodist Church at 4:30 p.m. on the last Sunday in July in New Fellowship Hall. This is a very informative meeting and anyone who has never been to camp before should plan to attend if at all possible. *Baggage needs to be at Sidney First United Methodist Church by 9:00 a.m. Saturday, if you want it to go on the truck to camp. We will need help loading the truck, so please plan to help if you are sending items on the truck. The truck will leave promptly at 10:30 a.m. *Transportation - Is the responsibility of parents to arrange for their son or daughter. Only in extreme cases will transportation be arranged by the Camp Committee. *Maps to Camp - Are available on the back of this sheet. *Arrival at Camp - When you arrive at camp, after 1:00 p.m., but before 3:00 p.m. - Report for registration and cabin assignments. There will be a meeting in the Lodge at 3:00 p.m. for all campers and counselors at which time, we will give out Camp Books, etc. *Departure from Camp - Will NOT be before 11:00 a.m. on Saturday morning. We will be involved in camp clean-up and campers will not be dismissed until after we have finished. In addition, state park rules say that all campers and staff MUST be out of the park by 12:00. *Medication - It is against the law for a Registered Nurse to dispense medication. Therefore, if there is any type of medicine at all that you think your child might take routinely, it is your responsibility to bring it to camp with you. This should be labeled and left with the Nurse. ADDRESS FOR TAR HOLLOW CHRISTIAN ADVENTURE CAMP Tar Hollow Resident Camp 16396 Tar Hollow Road Laurelville, OH 43135 Be sure the sender uses their Home Address for the return address (upper left hand corner), in case mail arrives after we have departed. PHONE: Lodge (Where we are) 740-887-3465 Office at Park 740-887-4818 Directions starting in Circleville: From Circleville, go Southeast on OH-56 for 15 miles. Turn Right on OH 180 and go South for ½ mile. Follow OH 327 South for 7 miles. Turn Right on Tar Hollow Rd (into the State Park) and follow the signs to the resident camp.
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