P.O. Box 548 Pomeroy, OH 45769
740-992-5353 / 2018
Registration Form 2018
Name: ______Male: ___ Female: ___
Address: ______
City: ______State: ______Zip: ______
Birth date: ______Age as of today: ______Going into school grade: ______or graduated 2018______
Parent(s)/Guardian Name: ______
Home Phone: ______Work Phone: ______Cell Phone:______
E-Mail Address: ______
Home Church: ______Phone: ______Minister’s Name: ______
Is your child likely to become homesick? Yes: ___ No: ___ Has your child been to OVCA before: Yes: ___ No: ___`
Has the child been immersed into Jesus Christ? Yes______No______
Please check the session you are registering for: All fees include Snack Shack
Mark / Session / Date(s) / Grade Entering / Regular Camp Fees / If Paid AFTERMAY 20, 2018
1st Chance / June 7-8 / 1st-2nd / $ 60.00 / $ 60.00
Senior High/Adventure / June 10-15 / 10th-11th-12th / $ 179.00 / $ 199.00
*White Water Rafting / June 10-15 / 10th-11th-12th / $ 100.00 / $100.00
Day Camp / June 16 / PreK and K / $ 30.00 / $ 30.00
Junior High / June 17-22 / 7th-8th-9th / $ 179.00 / $199.00
Junior / June 24-29 / 5th-6th / $ 179.00 / $ 199.00
Middler / July 8-13 / 3rd 4th / $ 179.00 / $199.00
Senior High and Adventure week will be combined. That week will consist of traditional as well as adventure activities for all campers. There is one exception: *Campers wishing to go on the whitewater rafting trip will need to pay an additional $100.00 tocover transportation cost and rafting fees. Those not rafting will be doing a different adventure activity at no additional expense. A $50.00 non-refundable deposit is required with your registration. Send checks or money order only made payable to Ohio Valley Christian Assembly. NOTE: The refund policy of OVCA is: Pro-rated refunds will be offered only to campers in cases of a death in the immediate family or for camper related medical conditions.
Amount your Church is paying: None: ______Full: ______Half: ______Other: ______
Name of Church paying fees: ______
First time OVCA camper (50th Anniversary) free camp:______
______
FOR CAMP USE ONLYDate Received:______
Registration Amount Paid:$ ______
Camper paid at camp:$ ______Cash ______Check ______Credit Card______
Paid by Church:$ ______
Bill Church:$ ______
Total Due at Camp:$ ______Cash ______Check ______Credit Card______
Instructions and Explanations for Registration
Pre-registration is of much value to the Dean’s planning and preparation for that week of camp. You are encouraged to send your registration in early.*Families sending more than one child may deduct$10.00 for the second or third child attending a full week camp.
Ohio Valley Christian AssemblyP.O. Box 548 Pomeroy, OH 45769
740-992-5353 / 2018
Ohio Valley Christian Assembly
P.O. Box 548 Pomeroy, OH 45769
740-992-5353 / 2018
Congregations that pay the entire amount of camp fees for their camp participants need not send a deposit with the registration. If the local congregation is not paying the fee, a $50.00 deposit should be included with the registration.
!!!!Do not send cash!!!! Checks and money orders are acceptable. Cash will be accepted at the camp during that weeks’ registration. We do accept credit cards.
Your child should be registered as to the grade of school they will be entering in the fall of 2018.
For example: A person entering the 8th grade in August/September 2018 would register for Junior High week.
All camp attendees should bring a pair of gym shoes or tennis shoes in addition to other footwear. One set of old clothes is also recommended.
Canteen (snack shack) money is included in the camp fees. There will be an offering taken every day for the support of a Mission project selected for the week. You are encouraged to financially support that project.
If a camper will be leaving camp during any camp day, a written authorization from the parent stating when the camper leaves, how often and who will be transporting the child, will be provided to the Dean on the first day of camp.
IT IS IMPORTANT FOR THE PARENT(S) TO UNDERSTAND THAT A CAMPER WILL NOT BE PERMITTED TO LEAVE THE CAMP WTIHOUT A WRITTEN AUTHORIZATION FROM THE PARENT/GUARDIAN AND THAT AUTHORIZATION MUST BE PRESENTED TO THE CAMP ADMINISTRATOR OR THE DEAN AT THE CAMP.
If there are questions regarding this policy, contact the camp or the Dean of the week.
ACTIVITY/MEDICAL RELEASE
Parent/Guardian must complete this page and sign below:
Child’s name______
Print the Child’s Name on the line above
Check any illnesses your child HAS had:
Ohio Valley Christian AssemblyP.O. Box 548 Pomeroy, OH 45769
740-992-5353 / 2018
□Mumps
□Measles
□Chicken Pox
□Ear Infection
□Asthma
□Rheumatic Fever
□Heart Disease
□Tonsillitis
Ohio Valley Christian AssemblyP.O. Box 548 Pomeroy, OH 45769
740-992-5353 / 2018
□Other: ______
______
Check any Allergies to which your child is susceptible:
Ohio Valley Christian AssemblyP.O. Box 548 Pomeroy, OH 45769
740-992-5353 / 2018
□Poison Ivy
□Penicillin
□Hay Fever
□Bee Sting
Ohio Valley Christian AssemblyP.O. Box 548 Pomeroy, OH 45769
740-992-5353 / 2018
List other Allergies to which your child is susceptible: ______
______
Current Inoculation Date for Tetanus (if known):______
The OVCA may give my child:
Ohio Valley Christian AssemblyP.O. Box 548 Pomeroy, OH 45769
740-992-5353 / 2018
□NONE
□Aspirin
□Tylenol
□Mylanta
□Pepto Bismol
□Benadryl
Ohio Valley Christian AssemblyP.O. Box 548 Pomeroy, OH 45769
740-992-5353 / 2018
□Other as specified:______
NO CHILD IS TO BE BROUGHT TO THE CAMP ILL. ALL MEDICINES MUST BE LEFT WITH AND DISPENSED BY THE CAMP NURSE. If your child has prescription medication, the CAMP will follow the directions on the bottle. DO NOT SEND MEDICINE OF ANY TYPE IN OTHER THAN THE ORIGINAL BOTTLE. If instructions have changed or need to be altered, please have your Pharmacist and/or doctor provide a new label before brining the medication to Camp.
We will always call parent/guardian first. Please list 2 emergency contacts in the case the parent/guardian can not be contacted.
For Emergencies Call:
1st Phone # (____) ______Relationship______
2nd Phone # (____)______Relationship______
Pediatrician / Physician Contact
Name ______Phone #______
Insurance Company ______Policy No.______
Name under whom camper is insured ______
I understand that in an emergency, OVCA will make every effort to contact those people listed on this form. In the event that OVCA is unable to contact myself or the designated emergency contact, I give my permission to the physician selected by the camp management to secure treatment for my child named on this form.
I understand that completion of this medical form with my signature grants the above named camper participation in all OVCA programs including swimming pool, climbing wall, and other field games and activities. I release OVCA staff, faculty, officers, and management from any liability and shall not be held responsible for any articles lost, stolen, or left at the camp. OVCA has my permission to use any video or photos taken of my child while attending or participating in a camp program to promote OVCA and its ministry (including website, facebook, and printed material).
Ohio Valley Christian Assembly insurance only assists medical injuries occurring during the duration of the OVCA program. Individual insurance coverage will be primarily responsible for extended coverage and OVCA will be limited secondary coverage only.
Parent/Guardian Signature______Date______
WHAT TIME DOES CAMP START AND END
The starting times for the weeks of camp are shown in the table below:
Session / Date(s) / Grade / Registration / Camp Start / Camp End1st Chance / June 7-8 / 1st-2nd / Thursday 9am / Thursday 9:30am / Friday 4pm
Senior High/Adventure / June 10-15 / 10th-11th-12th / Sunday 3pm / Sunday 5pm / Friday 3pm
Day Camp / June 16 / PreK and K / Saturday 9am / Saturday 9:30am / Saturday 4pm
Junior High / June 17-18 / 7th-8th-9th / Sunday 3pm / Sunday 5pm / Friday 3pm
Junior / June 24-29 / 5th-6th / Sunday 3pm / Sunday 5pm / Friday 3pm
Middler / July 8-13 / 3rd-4th / Sunday 3pm / Sunday 5pm / Friday 3pm
WHAT SHOULD I BRING TO CAMP
Bedding, Blanket, Pillow / Personal Care ProductsTwo (2) pair of shoes / Sandals if you want
Bible, Pen/Pencil and paper / Stamps for letters
Jacket and sweatshirt / Shoes for activities
Towel for swimming / Towel for bathing
Good attitude / Christian Behavior
WHAT NOT TO BRING TO CAMP
Electronic Devices / Firearms, Drugs, TobaccoNon-Christian literature / Shirts with inappropriate lettering
Shorts with lettering on the back / Inappropriate jerseys or tank tops
Tube tops and spaghetti straps are not permitted / Inappropriate jerseys or tank tops
Two-piece swimwear is not permitted
*Seniors just graduating in 2018 may attend the Senior week camp.