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Carolina Ministries Kids Camp 2017:
SPLASH
June 9th-June 12th, 2017
Camp Dixie Fayetteville, NC
Directed by Nate Didway
(SLT) Student Leadership Team will be hosting and helping during camp
Cost $190 if registered by May 9th
$225 after May 9th
Contact: Nate Didway - (828)638-3500 or Email:Nate.didway@gmail.com
The dates for Kids Camp (Directed by Nate Didway) and hosted by SLT are June 9th – 12th. Check in will be from 6:00pm to 8:00pm on Friday June 9th ; your group is responsible for their meal that night, and we need everyone checked in no later than 8:00pm. Kids Camp will end on Monday, June 12th at 11:00am. Camp will be held at Camp Dixie in Fayetteville. You can find out more about the camp and get directions at
The ages for Kids Camp is completed 1st grade – completed 5th grade. The cost for Kids Camp is $190 per person (camper and counselor) if postmarked before May 12th. If postmarked after May 12th it is $225. If money is paid, there can be no refunds; however, you may switch out names. This price includes all meals beginning with breakfast on Saturday through breakfast on Monday, as well as the camp T-shirt and all accommodations, activities, and crafts.
For Kids Camp, you must send one counselor for every eight children registered. If you are unable to send the proper number of counselors, please let us know. We may be able to locate counselors for you; however, your church will have to pay their registration fee. I have some college age students that would help out if you need them. We reserve the right to approve or deny all counselor applications
Please review the checklist below and make copies of all forms as needed. It is going to be an exciting camp and we are excited to see what God has planned as we spend an action packed weekend together. If you have any questions, please contact us via the above phone numbers or email address. See you at camp!
2017 Kids Camp Registration Form June 9-12 @ Camp Dixie
Email Form to:
Subject: Car Min Kids Camp
Make checks out to Carolina Ministries and mail to:
Nate Didway Carolina Ministries 631 Flintrock Dr. Boiling Springs SC 29316
Total Registrants: Kids______Counselors______
Church:______
Contact Person:______
Address:______
City, State, Zip:______
Email:______
Phone:______
Registrations $190.00 x _____=______
($225.00 after May 9th)
Shirts
Youth Small______
Youth Medium______
Youth Large ______
Youth XL ______
Small______
Medium______
Large______
XLarge______
XXLarge ______
XXXLarge______
Total Shirts:______
Male Adults
1.Name______
2.Name______
3.Name______
Male Students
1.Name______
2.Name______
3.Name______
4.Name______
5.Name______
6.Name______
7.Name______
8.Name______
9.Name____________
10.Name______
11.Name______
12.Name______
13.Name______
14.Name______
15.Name______
16.Name______
17.Name______
18.Name______
19.Name______
20.Name______
Carolina Ministries Kids Camp Registration Form
Name ______Age ______Sex ______
Home Address ______
City ______State ______Zip ______
Phone Number (_____)_____-______Birthdate ____-____-____
Home Church ______City ______
T-shirt Size (Circle One): YS YM YL YXL AS AM AL AXL A2X Other____
My child and I agree to the following:
____ I will obey all camp rules and schedules
____ I will not bring secular music, alcohol, tobacco
____ I will dress appropriately and realize that I cannot wear spaghetti straps, short shorts, tops that show my belly button, or two piece bathing suits
____ I agree to only use cell phones during designated times and will not have phone on during worship services. Misuse will result in loss of phone for the duration of camp.
____ I will leave all other electronics in my church vehicle
____ I will assume all risk for personal property and electronics. Camp time will not be used for locating lost items. If I am old enough to bring it, I am old enough to keep up with it.
____ I will be in my cabin at the designated time and realize that being outside of my cabin after curfew will result in immediate ejection from the camp.
____ I will be respectful of others.
By signing below, my child and I agree to the above terms. In regards to behavior and curfew, Camp Dixie is very strict. Security guards will roam the facility at night and anyone out after curfew will be brought to the directors. The directors will then be expected to call parents and have the child picked up. Failure to do so will result in the entire camp being asked to leave the facility with no refund of money.
______
Camper Signature Date
______
Parent Signature Date
Carolina Ministries Camp Liability Release Form
In consideration for being accepted by Carolina Ministries for participation in Kids and Teen Camp at Camp Dixie, Fayetteville, North Carolina, I (we) being 21 years of age or older, do for myself (ourselves) (and for and on behalf of my child-participant if said child is not 21 years of age or older) do hereby release, forever discharge and agree to hold harmless Carolina Ministries and the trustees thereof from any and all liability, claims, or demands for personal injury, sickness or death as well as property damage and expenses, or any nature above-described trip or activity.
Furthermore, I (we) (and for and on behalf of my child-participant if said child is not 21 years of age or older) hereby assume ALL RISK of personal injury, sickness, death, damage or expense as a result of participant in recreation, activity, ocean swimming activities involved therein.
Further, authorization and permission is hereby given to Carolina Ministries and trustees to furnish any necessary transportation, food, and lodging for this participant.
The undersigned further hereby agree to hold harmless and indemnity Carolina Ministries to furnish any necessary employees or volunteers/agents for any liability sustained by said church as result of the negligent, willful or intentional acts of said participant, including expenses incurred thereto.
This liability release form gives my child authorization to swim.
If participant has not attained age of 21 years fill out completely.
If under 21, both parents must sign unless parents are separated or divorced, or custodial parent must sign.
______
Father date
______
Mother date
______
Legal Guardian date
Participant name: ______
Parents Name: ______
Home/cell number: (______)______-______
Church Name : ______ph #:( ______)_____-______
Ins. Co. Name: ______ph #:(______)_____-______
Hospital Insurance ___ Yes ____ No Ins. Policy number: ______
Physician’s name: ______Physician’s ph #: ______
ER Contact person: ______
ATTENTION:
The campground offers a pool for swimming, a blob and slide on the lake, canoes, paddle boats, and go karts and this permission slip grants permission to participate in all of the above activities.
*By signing this form I agree to abide by all the rules and regulations of the Camp Dixie facility and the rules and directors of the 2017 Summer Kids Camp. Failure to do so will result in ejection from the camp.
CAROLINA MINISTRIES KIDS CAMP COUNSELOR APPLICATION 2017
(Must have all information on ALL counselors)
(qualifying age of 16 or older)
Name: ______Age ______M or F ______
Address:______
City: ______State: ______Zip: ______
Phone: Home (_____ ) ______-______Cell (_____ ) ______-______
Church Name/City: ______
Soc Sec #: ______-______- ______Date of Birth: _____-_____-_____
Email:______
All applicants MUST have their Home Church Pastor’s written recommendation attached to this application and must have a criminal background check conducted by Carolina Ministries.
Counselor expectations (please initial each line):
______I will be available to kids and groups at all times and will not leave my group unattended
______I will strictly maintain all camp policies
______I will not leave camp premises without approval of director
______I understand that all vehicles will be parked and cannot be driven around the camp facilities
______I will assist and encourage all campers to adhere to camp schedule and rules
______I will encourage all campers to mingle and participate in activities with other groups
______I will be a spiritual leader to campers and will encourage campers in their walk with Christ
______I will do my best to be a positive influence to campers and will refrain from the use of improper language, alcohol, tobacco, and drugs
______I will hold my cabin and group to strict adherence of the nightly curfew
______I will refrain from bringing secular music to camp
______I will adhere to camp schedule and will be on time to activities with my assigned group
By initial each space above and signing below, I agree to follow all camp guidelines. I also give my permission for Carolina Ministries of the Church of God, Inc. to run a criminal background check on me.
______
Signature Date
**Please remember to include a letter of recommendation from your local pastor**
Carolina Ministries Health and Medical Information Form
Name ______Date of birth______
Do any of the following apply? Please check…
___ Asthma___ Diabetes___ Physical Disability___ Sleepwalking ___ Allergies
___ Earches___ Heart Condition___ Seizures (does child need a bottom bunk Y or N)
Please list any special diet restrictions: ______
Date of last tetanus shot: _____-_____-_____ Immunizations are up to date: Y N
Allergic Reactions (circle all that apply):
Insect StingsAspirinPenicillinHay FeverOther______
If any of the above are circled, please give reaction and treatment needed:
______
I give my permission for camp staff to administer the following to my child as needed:
_____ Tylenol______PeptoBismal______Benadryl______Basic first aid creams
My child’s weight: ______(needed to administer proper dosages of some medications)
My child takes the following prescription medications:
Drug NameDosageFrequency
______
______
______
Please note: Our health staff cannot administer prescription medications unless they are in the original prescription bottle with the doctor’s instructions on the bottle. Please place all medication bottles in a ziplock bag with your child’s name on the outside.
I hereby certify that ______is in good health, free of any communicable disease and able to participate in all camp activities. In case of medical emergency, I hereby give my permission for the camp staff to treat my child with basic first aid or one of the over the counter medications listed above. In the event that my child needs further treatment, I give the camp staff my permission to hospitalize, secure proper treatment for, and order injection, anesthesia, X-rays, or surgery for my child as named above. I understand that, in the case of emergency, every effort will be made to contact me first; however, if I cannot be reached, the camp staff will act in the best interest of my child. I agree to cover the costs of any and all treatments. My signature below is evidence of my understanding of all above information and releases Camp Dixie, Carolina Ministries, and all staff of liability.
______-_____-_____
SignatureDate