O.D.C. CHILDREN FOR CHRIST CAMP – JULY 9- JULY 14, 2017

REGISTRATION FORM

OHIO DISTRICT COUNCIL HALLOWED HILLS CAMPGROUNDS

3129 East Pike Zanesville, Ohio 43701

CAMP DIRECTORS : Dr. D. W. Cummings & Minister Melanie Cummings-Bennett – 330 N. Main Street Wheeling, WV 26003

Phone: (304) 233-8899 Fax: (304) 233-8899 E-Mail: Website: www.children4christcamp.org

The Ohio District Council Children for Christ Camp accepts children entering Kindergarten through Grade 6 (this coming Fall school grade)

regardless of race, creed, color or ethnic background. * Refer to special note.

* SPECIAL NOTE: THE CHILDREN FOR CHRIST CAMP REGRETS THAT WE ARE NOT ABLE TO SERVICE CHILDREN WITH SPECIAL PHYSICAL AND MENTAL NEEDS DUE TO THE LACK OF STAFFING, FINANCES AND LIABILITY COVERAGE. IT IS OUR PRAYER THAT IN THE FUTURE, WE WILL BE ABLE TO SERVICE SPECIAL NEEDS KIDS. WE DO RECOMMEND, HOWEVER THAT PARENTS SEARCH THE INTERNET AND OTHER RESOURCES FOR CAMP PROGRAMS SPECIALLY DESIGNED FOR CHILDREN WITH SPECIAL NEEDS.

PLEASE PRINT AND COMPLETE THE FOLLOWING REGISTRATION and T-SHIRT INFORMATION.

CAMPER’S NAME ______M ______F ______Age ______

ADDRESS______

CITY/STATE/ZIPCODE______

BIRTHDATE ______FALL 2016-17 SCHOOL GRADE K 1st 2nd 3rd 4th 5th 6th

PARENT/GUARDIAN______HOME PHONE ______

EMAIL: ______CELL PHONE: ______

CHURCH ______PASTOR ______

***T-SHIRT (CIRCLE 1)***

CHILD SIZES: SMALL, MEDIUM, LARGE - ADULT SIZES: SMALL, MEDIUM, LARGE, XLARGE

PARENTAL PERMISSION FOR WATER BAPTISM (Read & sign only once): I, ______, hereby authorize permission for my child, ______, to be baptized in the name of Jesus if they choose to, according to Acts 2:38 during his/her stay at the Ohio District Council Hallowed Hills Campground during July 9-July 14, 2017.

OR Sign here:______if your child has ALREADY been baptized in Jesus name.

OR Sign here:______if your child has not been baptized & DOES NOT have permission to be baptized

IN CASE OF EMERGENCY…

NAME______PHONE______

NAME______PHONE______

EARLY BIRD REGISTRATION: CAMP FEE $100.00/ CAMPER IF POSTMARKED BY APRIL 30, 2017.

TUITION: The general tuition for campers is $125.00. Senior Citizen tuition is $75.00.

Please check the tuition fee that applies to this applicant:

q  Scholarship Amount: $______Provided by: ______

q  Early-Bird Camper Tuition Fee - $100.00 Camper Tuition - $125.00

q  Cash Enclosed Money Order Enclosed Internet Payment-Please attach copy of receipt

q  Senior Citizen Tuition - $75.00

ü  NOTE: TO GUARANTEE ADEQUATE MATERIALS FOR EACH CAMPER, ALL TUITION REGISTRATION FEES WILL BE & MUST BE PRE-PAID.

ü  THE DEADLINE FOR REGULAR REGISTRATION IS JUNE 25, 2017. ($125.00).

ü  ALL REGISTRATION FEES MUST BE PAID WITH A CASHIER’S CHECK, CHURCH CHECK, MONEY ORDER OR CASH.

NO PERSONAL CHECKS ACCEPTED. MAKE CASHIER’S CHECK, CHURCH CHECK OR MONEY ORDER

o  PAYABLE TO: O.D.C. CHILDREN FOR CHRIST CAMP

o  & MAIL TO: ODC C4C CAMP, Minister M. Cummings, P.O. Box 6051, Wheeling, WV 26003

Photo/Video Release Form for Minor Children

I hereby authorize ODC Children 4 Christ Camp to publish the photographs & videos taken of me and/or the undersigned minor children, and our names, for use in the ODC Children 4 Christ Camp website and for display in marketing. I release ODC Children 4 Christ Camp from any expectation of confidentiality for the undersigned minor children and myself and attest that I am the parent or legal guardian of the child named on this application and that I have the authority to authorize ODC Children 4 Christ Camp to use their photographs and names. I acknowledge that since participation in publications and websites produced by ODC Children 4 Christ Camp is voluntary, neither the minor children nor I will receive financial compensation. I further agree that participation in any publication and website produced by ODC Children 4 Christ Camp confers no rights of ownership whatsoever. I release ODC Children 4 Christ Camp, its contractors and its employees from liability for any claims by me or any third party in connection with my participation or the participation of the undersigned minor children.

Signatures: (Parent/Guardian) ______Date: ______