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2010 Western Camp Application July 12-18, 2010 Age on 7/12/10 Name: Address: City, State and Zip Code: Phone #: E-Mail: Check those that apply: Home Church: Male Female Married Single Roommate, housing, part-time requests: ____________________________________________________________ Willing to serve, PLEASE CHECK AT LEAST ONE: Cabin Counselor Jr. Dept. Teacher Nursery Sound Helper Adult Teacher Jr. Dept. Helper Piano Player Power Point College/Career Teacher Jr. Choir Director Song Leader High School Teacher Jr. Choir Helper Special Number Junior High Teacher Craft Helper I have read the information on this sheet and agree to abide by all guidelines. Applicant's Signature Parent's Signature* Guardian's Signature* *For anyone 18 and under who comes to Camp without a parent, these are the requirements: Parent's Signature, Guardian's Signature and completed and signed Medical Release / Liability Forms *ATTENTION PARENTS: Children 12 years and under will stay with parents. Children under 18 years old must be accompanied by their parents or guardian. *CURFEW POLICY: Any campers not in their assigned room(s) after lights out will be warned of their negligence. If a second warning is received, the camp advisory board will take disciplinary action. *ZERO TOLERANCE POLICY STATEMENT: There will be ZERO TOLERANCE for the following misconduct: Inappropriate sexual behavior; possession or use of illegal drugs, tobacco, or cigarettes; unauthorized leaving of campgrounds. For any of the above violations, parents will be made aware and accountable, with the possibility of the violator being sent home from camp. REMEMBER TO BRING: Your Bible, notebook, musical instruments, warm clothing, flashlight. Also, no skateboards or roller blades, please. - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - FROM THE SOUTH: FROM THE NORTH: Exit I-5 at Exit 206 Exit I-5 at Exit 212 (Lakewood/Smokey Point). (Stanwood/Camano Island). Turn left onto 172nd St. N.E., Turn right onto Highway 532 Cross over freeway and and travel 5¼ miles west to proceed 2¼ miles to the first Stanwood. Turn left at the 3rd stop sign. Turn right onto light onto 88th Ave NW and Lakewood Rd. and travel 6 go ¼ miles to stop sign. Turn miles to the stop sign at Marine right onto Marine Dr. and Dr. Turn right on Marine Dr. travel south for 4 miles to and go 1¼ mile to camp camp entrance on the right. entrance on the left. WARM BEACH CAMP: 20800 Marine Drive; Stanwood, WA 98292 (360) 652-7575 or 1-800-228-6724 (WA only ); fax: (360) 652-8210 or www.warmbeach.com REGISTRATION FEE FOR ALL CAMPERS ~ Non-Refundable $10 on or before June 1 $30 after June 1 Registration Subtotal $ FULL-TIME RATES ONLY Type of Lodging Adult 5 ~ 12 0~4 Olympic View $435 $125 0 Mt. Baker $395 $125 0 Cascadian $350 $100 0 Glacier / Whistler $250 n/a n/a Camper $160 $100 0 Full-Time Subtotal $ PART-TIME RATES ONLY Select Meals for Part-Time 13 + 5 to 12 M T W T F S S Daily Flat $ 15.00 $ 5.00 Rate Part-Time Meals Subtotal $_______ Select Lodging for Part-Time OV $ 75.00 $ 25.00 Mt. Baker $ 50.00 $ 25.00 Casc $ 45.00 $ 20.00 GL / WH $ 20.00 n/a Campsite $ 20.00 $ 15.00 Part-Time Lodging Subtotal $_______ SUBTOTAL OF FEES $ ADJUSTMENTS AND DISCOUNTS $50 ~ Travel Discount (for those living outside of WA, OR, ID & BC) $( ) Church Subsidies for Children under 17 ~ fill in amount your church provides $( ) 5% Canadian Discount $(______) Subtotal of Amount Due: $ ______ Amount Paid: $( ) TOTAL AMOUNT DUE: $ _______ --------------------------------------------------------------------- Make check or money order payable (in US Funds Only) to: Western Camp ACC Complete, sign and return application to: Jane Toth, 501 Catskill St, Richland, WA 99354. For more information, email firstname.lastname@example.org or call (509) 946-8444. Lodging Descriptions: Olympic View: Hotel style lodging ~ private bath, queen bed & single day bed w/ trundle Mt. Baker: Family lodging, queen bed, 4 bunk style beds and private bath in each room Cascadian: Lodge Style, queen bed, 2 daybeds, vanity sink, community bath/showers per wing Glacier/Whistler: Singles lodging ~ bunk bed, community bath *Rates include lodging, linens (sheets, pillow case, blanket in all accommodations except the camp sites), towels and meals from supper Monday 7/12 through lunch Sunday 7/18 For more info on rooms and camp facilities, go to www.warmbeach.com For more information, camp applications and Medical release/liability forms, go to www.accwesterncamp.com _ _
"2010 Western Camp Application"