Bounce 2009 – Church Group Registration Form Once again we are blasting off with Bounce. A District sponsored event at Braeside Camp Grounds sure to put some BOUNCE into your end of year mid-week club celebration. This over night event beginning the evening of Friday June 5th till Saturday June 6th promises to be a terrific time filled with lots of fun activities, worship & devotional services, a “choose your own adventure” activity afternoon sure to delight your campers and leaders alike. We‟re thrilled that you and your church are going to join us this year for bounce. Much of what you need to know, scheduling, activities, Bible quiz information (optional), is on line at www.kidzvillage.ca Step 1 Decide which accommodation option you plan on advertising (can be a combination of both if you want and you have leadership for both areas) There are 2 choices for accommodation this year as we are quickly busting the seams of Braeside Camp Grounds. If you choose the tenting option, please note that this includes a tenting site (with electrical and water), you need to provide the tent and gear required for you and your campers. If you choose the dorm option please note that your campers will be required to bring their sleeping bag and pillow along with their toiletries. Step 2 Personalize the Welcome to Bounce Parents newZ letter available on our web site at www.kidzvillage.ca (click on the Bounce Poster). Use this letter as a cover letter to the Bounce Camper Registration form also available on the web site. It is your responsibility to ensure that all registered campers have a completed registration form with medial information and signed waiver. Step 3 Collect the forms by the due date and fill in the bottom of this sheet. Fax this information to the district office at (905) 637-7558 OR save file to your hard-drive, make changes, and then email to Heather Crooks at the District Office. Once the fax or email is received and payment has been processed you will get a confirmation from Heather Crooks (firstname.lastname@example.org) WOW that was easy… :) __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Church Name ___________________________________________ Leaders Name _______________________________________ Leaders Contact Email Address (print carefully) _____________________________________________________________________ Tenting Option Number of MALE camper‟s _____ Number of MALE leader‟s _____ Number of FEMALE camper‟s _____ Number of FEMALE leader‟s _____ Total Number (leader‟s and campers) _______ X $26.25 ($25 + $1.25 GST) = ________ Dorm Option Number of MALE camper‟s _____ Number of MALE leader‟s _____ Number of FEMALE camper‟s _____ Number of FEMALE leader‟s _____ Total Number (leader‟s and campers) _______ X $36.75 ($35 + $1.75 GST) = ________ Payment Options $ ________________ Total amount remitted (tenting option total + dorm option total) _____ Check (mailed to the district office attention Heather Crooks/Bounce) _______ Credit Card ___ m/c ___visa Card Number ________________________________ Expiry Date ______________ 3digit code on back _____________ Name as it appears on the card _____________________________________ Signature ___________________________ By submitting this registration form I am committed that I have done due diligence in obtaining completed registration forms and any over night trip form or drivers forms required by my church and parents. I have given my parents full information concerning their child‟s whereabouts and have left them emergency contact information for myself as the leader to use if necessary. Bounce camp out adventure june 5th & 6th (braeside camp grounds) Church Group Name __________________________________________ (here after named „said church”) Child‟s Name ___________________________________ Age _______ Birthday ________________ Male ____ Female ______ Email Address __________________________________ Mailing Address ____________________________________________ City ___________________________ Prov. ______ P/C ___________________ Home # _____________________________ Work # _______________________________ Name of Emergency Contact ____________________________________ Phone # ____________________________________ Medical Information (Please check all that apply) __ Asthma __ Epilepsy __ Diabetes __ Allergies (bee sting, peanut, food, environmental) __ Bed wetting concerns Does your child... Require medication at camp? __ Yes __No Have any special diet needs? __Yes __ No Have any learning, emotional or physical challenges? __Yes __No Have all updated tetanus shots? __ Yes __ No Can your child be given over the counter medication should they require it, as determined by their church leader, (i.e. for headache, stomach ache) __Yes __No Have you checked your child‟s head for lice? __Yes __No (If answering No, please do so prior to sending them to Bounce for the convenience of all) Health Card # __ __ __ __ - __ __ __ - __ __ __ - __ __ Doctors Name____________________________________________ Doctors Phone # __________________________________________ Medical Information Details __________________________________________________________________________________ (Attach additional sheet if necessary) ________________________________________________________________________________________________________ I understand that while every reasonable precaution shall be taken to ensure the good welfare and protection of each participant, I release said church, its board as well as any of the church staff, board, and adult sponsors, in the event of any accident in route, during, and returning from this event. I give my permission for transportation to and from the event to be arranged by said church and release said qualified driver of any and all liability in the event of an accident causing injury or death. I release the camp, its directors, staff members and counselors from any and all liability in the event of personal loss or injury. I authorize the event photographer to photograph said participant for use in event promotion printed material, and final service photograph presentation. In the event of a medical emergency, I understand that every effort will be made to contact parents / guardians. In the event I cannot be reached or to contact me would mean a significant delay in treatment, I authorize the Leader Representative of said church to act on my behalf to secure the services of a licensed physician to provide the care necessary including any anesthetic or surgery for my child's well being. In the event that my child should require basic medical treatment (i.e. sore throat, rash, earache) I give permission to the staff to secure proper treatment. Parent or Guardian‟s Name __________________________________ Signature ______________________________________ Date ___________________________ Payment: Total Event Cost: $ ________ Attached: Check (payable to your local church, memo Bounce) Cash NOTE: Church Leaders please DO NOT send this form to the District Office. This is for your records and should accompany you to the event in the case of an emergency. To register your group please forward the registration summary sheet available on line at www.kidzvillage.ca Welcome to Bounce – Sample Cover Letter to Parent‟s This year the kids in our mid-week club have the opportunity to attend an end of year celebration at Braeside Camp Grounds. It‟s an over night event beginning the evening of Friday June 5th till Saturday June 6th. It promises to be a terrific event filled with lots of fun activities, worship & devotional services, a “choose your own adventure” activity afternoon sure to delight campers and leaders alike. We would love for your child to come and be a part of all the fun that Bounce has to offer. _______________________________________________________________________ Other things you will need to include in your personalized parent‟s letter as the mid week club leader… 1) cost of the event a. $35 for the sleepover in a dorm / trailer accommodation Bring: Sleeping Bag, Pillow & Toiletries b. $25 for the sleepover in a tenting space (electricity and water available) Bring: Tent, Sleeping Bag, Mattresses (if desired), Pillow & Toiletries c. NOTE: You may however need to add in money for your transportation costs, or a trip to McDonalds or Braeside tuck shop grill as you leave to travel home… 2) When your buses will depart the church 3) When kids will need to be picked up on the Saturday at the church. 4) If you are competing in the Bible Quiz Competition or bringing Cub Cars to the exhibition race you will want to include information about that. 5) You will want to add information about your registration deadline. Our on-line registration is open from April 1st to June 1st, however you will want to have all the money and registration forms collected before you, as the leader enter all the registration totals into the Church Group Registration form and fax it to the District Office. 6) You will need leaders to come with your group, and may want to add that information in. I would assume that your children‟s ministry volunteers whom already assist you in the mid week club would be coming with your group, however if that‟s not the case ensure whom ever you are bringing is fully trained in plan to protect. You will need about 1 leader for every 8 kids you bring. Keep in mind gender as you will need leaders for each gender to ensure proper behavior and any assistance that is required in the night time hours. 7) You may want to enter in information about the code of conduct that you expect campers to abide by since you and your leaders are ultimately responsible for their well being and supervision during the day and night. 8) You will want to have medical sheets on all your campers, including their health card information, emergency contact information, any medication coming with them etc. If you are looking for copies of sample overnight trip forms look at the appendix section of your plan to protect manual to find one that‟s right for your church. Note to Children’s Pastor / Leader: Feel free to contact Heather Crooks at email@example.com or Pam McArthur firstname.lastname@example.org if you have any questions or concerns. Please refer to the information package that was sent to all WOD Pentecostal Churches in early March 09 for further information, bounce planning guide and poster information.