Kamp KoinoniaKAMPERApplication 2014

Check Camp attending below – Circle One below –

TEEN KAMP – June 22-28(Completed 7th – 12th grade) –Fee $190 T-Shirt Size:

Must be 11 yrs. 6 mo. by June 1st, 2014 and completed 7th grade

PRE-TEEN KAMP- June 29-July 4(Completed 3rd – 6th grade) –Fee $180Youth S M L

Must be 8 yrs. 6 mo. by June 1st, 2014 and completed 3rd grade

Adult S M L XL

A $25 deposit must be turned in by June 1, 2014

FOR OFFICE USE ONLY:

Payment Received: Cash or Check: Check #:

Please PRINT all information requested –

Age: Date of Birth: Grade: Sex: Male or Female

(mm/dd/yyyy) (grade just completed May2014)

Name

(Last)(First)

Street Address

City/State/Zip

Phone: Home (_____)______Cell(_____)______

Home Congregation: Have you been baptized? Y or N

Parent/Guardian Information

FatherMother

Parents Address

Parents Home Phone ( ) Cell

Email:

Emergency Contact Name: Phone:

Will YOUR CHILD NEED TRANSPORT TO AND FROM THE CAMP? Y or N

I agree to abide by the rules and policies of the management of this camp. I understand that if I willfully disregard camp rules, I may be dismissed from camp. I have read, understood and signed the Special Instructions on the back of this application.

Campers Signature:

I give my approval for my child to attend this camp. I hereby relieve Kamp Koinonia,Texoma Youth Camp, Cedar Hill Church of Christ and camp staff from any and all liability for sickness or injury of any nature or cause whatsoever while attending or traveling to or from camp. I hereby authorize the CampDirector or Nurse to obtain medical treatment in case of an emergency. I agree to pay all expenses related to any emergency medical treatment administered. I have read and I understand the Special Instructions on page 3 of this application.

Parent/guardian (if under 18) or personal signature:

Please Complete Medical Information on Page 2 of this Form

Mail this completed application/medical information form and a $25 deposit by June 1, 2014 to:

Cedar Hill Church of Christ, 535 S. Clark Rd, Cedar Hill, TX 75104.

Kamp Application 2014 – Medical Information

BE SURE TO COMPLETE ALL SECTIONS!

Name:

(Last)(First)

Emergency Contacts / Home Phone and Cell Phone:

MEDICAL INFORMATION:

Insurance Company & Policy # / Family Doctor & Phone #
Diabetes: Yes or No
Asthma: Yes or No
High Blood Pressure:
Date of Latest Tetanus Shot: (YEAR) (Do not leave blank)
TYLENOL OR ASPIRIN
List ALL current medical conditions, handicaps, allergies, etc.
List ALL medications you are currently taking (Turn medications into the nurse upon arrival)
Medication Dosage Time of Day

** Mail this completed application/medical information form and a $25 deposit by June 1, 2014 to:

Cedar Hill Church of Christ, 535 S. Clark Rd, Cedar Hill, TX 75104. **

Kamp Koinonia 2014Special Instructions:

It is vital that forms are turned in to us in a timely manner in order to make all preparations required.

This includes preparations for transportation, meals, and lodging.

Pre-Registration:

  1. Complete and sign the application and medical form.
  2. Mail the form with a $25 deposit to the address on the bottom of the form by June 1st.
  3. Make checks payable to “Cedar Hill Church of Christ”.

Kamp Check-in:

Check the Church Website for information

  1. Check-in is at the Cedar Hill Church of Christ or at the camp on the 1st day. At check-in, you will sign your child in and upon pick-up at the end of the week; you must sign your child out. If you are checking in at camp and not the building, please notify the director at least one day in advance.
  2. Registration Fees must be paid in full at check-in time.
  3. A completed and signed registration and medical form must be turned in for a child to attend camp.
  4. Transportation is available from Cedar Hill Church of Christ to and from the camp. Please indicate on the application form if transportation is needed.

Dress:

Modest clothing should be worn at all times.Sleeveless shirts are permissible if fitted around the arms and shoulders, and cover most of the shoulders.Types of clothing excluded: short shorts, mini-skirts, halter tops, spaghetti straps, midriffs, and t-shirts with inappropriate sayings. Staff decisions on the appropriateness of attire should be cheerfully honored.

Swimwear must be modest. Girls wearing two-piece swimsuits must also wear a t-shirt.

Specific Items:

  1. Cellular phones only to be used in case of emergency. Phones that are brought will remain in luggage during camp.
  2. Use of personal Electronic games or CD players will be limited to specific times of the day if brought. Camp staff will not allow these items to become a distraction so expect them to stay in luggage most of the time.
  3. Tobacco, drugs or alcohol of any kind are prohibited at camp.
  4. Fire works, matches or lighters are prohibited at camp.
  5. We are not responsible for lost or damaged items.

Mail:

Mail must be sent by Wednesday to be received by Friday. No mail is forwarded and campers have to supply their own stamps. Send mail for the Teen/Pre-Teen camp to: “Person’s Name,” Texoma Youth Camp, 26368 Preston Bend Rd., Pottsboro, TX 75076. (In case of emergency only, the camp phone #’s can be obtained from the church office at 972-291-4200.)

Things TO Bring:

1