Missions Adventure Camp Completed camper’s forms with remaining balance are to be mailed to Alabama WMU by June 3, 2016 2016 Missions Adventure Camp Forms Checklist Please arrange forms in the following numerical order before sending in: ** MUST BE RECEIVED NO LATER THAN 2 WEEKS PRIOR TO CAMP DATE TO THE ALABAMA WMU OFFICE! Activities Permission & Release (page 1) Camp Policies (page 2) Health History (pages 3 & 4) **Insurance Card (front and back) attached to health form (5) Photo Release & Camper Release (page 6) Camper Information Sheet (page 7) Remaining Camp Balance Please note: All papers need to be signed and some pages need more than one signature! Only if child has medication ** Medication Instructions (page 8) Do not mail, bring to camp Mail these forms, along with your remaining balance to: Alabama WMU Camp PO Box 11870 Montgomery, AL 36111-0870 Name: ____________________________ Date Attending: June 20-24__________
Transcript
Missions Adventure Camp
Completed camper’s forms with
remaining balance are to be mailed
to Alabama WMU
by June 3, 2016
2016 Missions Adventure Camp
Forms Checklist
Please arrange forms in the following numerical order before sending in:
** MUST BE RECEIVED NO LATER THAN 2 WEEKS PRIOR TO CAMP DATE TO THE ALABAMA WMU OFFICE!
Activities Permission & Release (page 1) Camp Policies (page 2) Health History (pages 3 & 4) **Insurance Card (front and back) attached to health form (5) Photo Release & Camper Release (page 6) Camper Information Sheet (page 7) Remaining Camp Balance
Please note: All papers need to be signed and some pages need more than one signature! Only if child has medication ** Medication Instructions (page 8) Do not mail, bring to camp
Mail these forms, along with your remaining balance to:
Alabama WMU Camp PO Box 11870
Montgomery, AL 36111-0870
Name: ____________________________
Date Attending: June 20-24__________
Arrival at Camp:
Check-In begins at 10:00 a.m. and concludes at 1:30 p.m. There is no need to arrive earlier than 10:00 a.m. as we will not be ready to check in campers until that time.
As you enter the camp gate, you will be greeted by camp staff who will give you written instructions for the check-in procedure. Campers need to be present with their leaders or parents for this process. Also, all medications, daily medication form and store money needs to be with you.
Restrooms are located outside of the Chapel, near the entrance. Departure from camp:
Closing Service will begin at 12:30 p.m. in front of Dogwood. Please gather behind the roped off area.
Camper pick-up will be after the Closing Service in the roped off area closest to the luggage.
Driver’s License Required: Person picking up campers MUST have a valid driver’s license & be listed on the Camper Release form. Be sure the name given on the Camper Release Form is the legal name matching the name on their Driver’s License.
GPS Address: WorldSong Missions Place
1200 WorldSong Road Pell City, AL 35125
Things to Bring 2016 Missions Adventure Camp
Your child’s experience at camp will include meeting missionaries, Bible Study, games, hiking, swimming, making new friends and so much more! Camp is special because it allows your child to come away from the distractions of everyday life, have fun and be focused on God and how He is working in their lives and the lives of people all over the world. Alabama WMU takes seriously this opportunity and we thank you for allowing us this incredible time with your child.
For your child to have the best experience possible, we strive to remove as many distractions from camp and the camper as possible. This includes leaving all of the following at home: cell phones, iPods, tablets, mp3 players, electronic games or other electronic devices. We have found that bringing these items to camp distracts the camper and others around them from all that God wants them to experience.
NOTE: Please label all personal items brought to camp
Items to bring:
□ Bible and pencil or pen □ Personal items such as soap, shampoo, toothpaste, toothbrush, hairbrush, deodorant, etc. □ Water bottle (REQUIRED) □ Flashlight □ Sleeping bag (or twin sheets) □ Pillow and blanket (cabins are air conditioned and can get cool at night) □ Towels (for pool and shower) □ Wash cloths □ Shorts of appropriate length (Denim shorts are not recommended) □ Shirts
□ Tennis shoes (closed toed shoes with good traction are required for all activities)
□ Extra shoes (in the event one pair gets damaged or wet)
□ One-piece swim suit (No bare midriffs) □ Pajamas □ Shower shoes (flip flops will do) □ Rain jacket (no umbrellas) □ Backpack (needs to be sturdy, no drawstring bags as these are uncomfortable when carrying all day long). □ Bug spray/wipes □ Sunscreen □ Medicines (see Daily Medication Instructions) NO MEDICATIONS are allowed in the cabin. □ Money - missions offering and store money (most campers bring $20 - $40), placed in a zip lock bag with camper’s name and amount written on slip of paper in bag.
PLEASE - NO open toed shoes, halter tops, short shorts, or ultra-miniskirts.
Things to know: Forms (except Daily Medication Instructions) - Completed, signed and mailed to the Montgomery
office in order to facilitate registration (Alabama WMU Camp, PO Box 11870, Montgomery, AL 36111-0870) Medication Instruction Forms need to accompany medications on arrival.
Release Form - Your camper will only be released to one of the persons listed on their release form. The persons picking up campers must present a valid driver’s license. Name on release form must match name on Driver’s License. Please list more than one person in case of an emergency.
Health screen - According to American Camping Association standards, each camper must be screened by a health care professional upon arrival at camp. This will be a basic check of the general physical condition of your camper. Staff will check ears, eyes, nose, throat and temperature. Please bring all medicines to registration with Daily Medication Instructions. All medications need to be in their ORIGINAL containers.
Lice Screening- Each child will be checked for head lice during registration. We will adhere to the following: HEAD LICE POLICY
o Any camper who is confirmed to have either live lice or ‘nits’ (lice eggs) will have TWO OPTIONS. 1. They may leave camp. OR 2. They may receive treatment consisting of the following:
Parent or church leader must administer a full lice treatment (can be done at the pool house). A treatment kit can be purchased through the infirmary or on your own.
ALL of camper’s bedding and laundry must be washed (washing machines available at the pool house).
Camper’s luggage must be placed in a black plastic bag and left to sit in a sunny area for 48 hours and will afterwards be returned to camper’s cabin discreetly.
All steps must be completed before camper will be allowed to join their cabin. Camp staff are available to facilitate the treatment needs only and are not available to do the treatment or handle washing of the laundry.
It is our desire NOT to send any camper home due to a lice situation, but this requires the cooperation of the parent or church leader. Thanks for your help!
Buddies - Changes regarding cabin assignments cannot be made at the camp registration desk. No more than 2 campers from the same church or group will be allowed in the same cabin, except in cases of an odd number of campers. Please list your camper’s buddy on Camper Information Sheet.
Parents and leaders are invited to attend the closing service. Children will not be released prior to closing ceremonies on the last day of camp.
Phone- The camp only has one business phone. Campers will not be allowed to use the phone. If there is an emergency, the Missions Adventure Camp Director will contact you.
Registration/Closing Schedules
Missions Adventure Camp for Girls/Teen
Registration: 10:00 a.m. Monday
Closing Service: 12:30 p.m. Friday
Dismissed: 1:30 p.m. Friday Mini and Extreme Missions Adventure Camp for Girls
Registration: 10:00 a.m. Monday
Closing Service: 12:30 p.m. Wednesday
Dismissed: 1:30 p.m. Wednesday Missions Adventure Camp for Children
Registration: 10:00 a.m. Monday
Closing Service: 12:30 p.m. Friday
Dismissed: 1:30 p.m. Friday
Mission Adventure Camp for Mom & Me
Registration: 1:00 p.m. Thursday
Dismissal: 1:30 p.m. Saturday
Missions Adventure Camp for Mom & Me Little
Registration: 4:00 p.m. Friday
Dismissed: 3:00 p.m. Saturday
Missions Adventure Camp for CITs
Registration: 10:00 a.m. Monday
Closing Service: 12:30 p.m. Friday
Dismissed: 1:30 p.m. Friday
Activities Permission and Release
This form must be completed in order for you or your child to participate in activities.
Participant (age 18 or older)
I, (PRINT NAME) _______________________________________, do release the WorldSong staff or volunteers, WorldSong Missions Place and Alabama WMU from all claims that might arise in the event of injury as a result of the activities in which I participate.
--- OR ---
Parent/Legal Guardian (of participant under age 18)
I, (PRINT NAME) _____________________________________________________________, the parent or legal guardian of (PRINT NAME) ________________________________________________, hereby give permission for my child to engage in any of the activities sponsored by WorldSong Missions Place during the time span for which they are registered. In the event of injury, I do release the WorldSong staff or volunteers, WorldSong Missions Place and Alabama WMU from all claims that might arise as a result of the activities in which the campers participate. Adventure Recreation Philosophy Along with traditional camp activities such as hiking, canoeing, archery, sports, and field games, WorldSong also features adventure recreation activities including, but not limited to, low ropes, high ropes, zip line, and climbing wall. Adventure recreation activities are specifically designed to develop self-confidence, build trust, and teach spiritual truths. I understand that WorldSong Missions Place follows and promotes the philosophy held by the Association for Challenge Course Technology (ACCT) of “Challenge by Choice” where participants are encouraged to learn about and try new physical challenges, but the choice of participating is always theirs alone. Never will any participant feel pressured to perform any challenge with which they are not comfortable. Also, note that while there are no age limits for participation on the zip line, proper fit of safety gear (harness and helmet) is a requirement. If the safety gear (harness and helmet) is too large or too small, the participant will not be allowed on equipment for obvious safety reasons.
If for any reason you or your camper has any physical limitation that might prevent you or him/her from participating in any or some activity, please list limitations below.
❖ _________________________________________________ _________________ Signature of Participant or Parent /Guardian Date
Signature of Witness Date Note: While we at WorldSong Missions Place strive to provide the safest environment possible, you are still in a natural environment. Some aspects of your experience with us will be outside of our control, including weather, animals and insects. Therefore, it is important to always remain alert as to your surroundings.
1.
Camp Policies
Campers are expected to remain at camp for the entire camp session.
Campers and parents are expected to cooperate with camp personnel regarding living area assignments. Campers are assigned according to buddy choice. No more than 2 campers bunking together from the same group or church, except in cases of an odd number of campers. This will allow campers to make friends with others in the cabin.
In order for campers to have the best week possible, without distractions, campers are not allowed to have cellular phones. If there is an emergency, the Missions Adventure Camp Director will call the parent or guardian.
No mp 3 players, i-Pods, electronic games or any other electronic devices, food or gum may be brought to camp.
Campers are expected to cooperate with the Cabin Leader and other campers in their cabin. It is necessary for the campers to work together.
Campers are expected to cooperate with corrective measures deemed necessary by the Cabin Leader and/or activity instructor. Corrective measures will never involve physical, emotional or verbal abuse. When serious problems arise, the Missions Adventure Camp Director will be consulted.
Campers are expected to wear athletic type shoes while at camp. No sandals or flip flops may be worn except for banquet. “Crocs” are not permitted.
When requested to do so, parents are expected to pick up a camper in the event of serious disciplinary or medical problems as deemed necessary by the Missions Adventure Camp Director.
When picking up a child, the driver will be asked to sign out the camper(s) and show a valid driver’s license. The name on the release form must match the name on driver’s license. Only people listed on the Camper Release form will be allowed to pick up that camper.
The camp program is designed for each camper to grow in their relationship with God, develop relationships with other campers and staff and participate in a variety of activities such as swimming, Bible study, mission study, worship, recreation, hiking, etc.
Please note any valid limitations or exceptions your child may have: ____________________ _________________________________________________________________________
I have read these camp policies and have talked with my camper about them. We understand that my camper is expected to abide by them.
Signature _________________________________________________ Date _____________ (Parent or Guardian)
2.
Name_________________________________________________________________ Birth date_____________ Age________ Last First Middle
Parent/Guardian _________________________________________________ Home Phone (____) ________________________
Work Phone (____) ________________________ Cell Phone (____) ________________________
Home address ______________________________________________________________________________________________ Number/Street City State Zip
Name of Home Church: _________________________________________________________________________ Name of Church/Group attending camp with (if different from above):____________________________________________________
ALLERGIES (If yes, please check all that apply) Hay Fever, etc. Poison Ivy/Oak/Sumac Insect Stings Penicillin Aspirin Other Details_____________________________________________________________________________________________________
General Questions (If “yes” please explain) Has/does the participant: Yes No
1. Had any recent injury, illness or infectious disease?
2. Have a chronic or recurring illness/condition? 3. Ever been hospitalized? 4. Ever had surgery? (give details below*) 5. Have frequent headaches? 6. Ever had a head injury? 7. Ever been knocked unconscious? 8. Wear glasses, contacts or protective eye wear? 9. Ever had frequent ear infections? 10. Ever passed out during or after exercise? 11. Ever been dizzy during or after exercise? 12. Ever had seizures? 13. Ever had chest pain during or after exercise? 14. Ever had high blood pressure? 15. Ever been diagnosed with a heart murmur?
Yes No
16. Ever had back problems?
17. Ever had problems with joints (e.g. knees, ankles)?
18. Have orthodontic appliances being brought to camp?
19. Have any skin problems (e.g. itching, rash, acne)?
20. Have diabetes?
21. Have asthma?
22. Had mononucleosis in the past 12 months? 23. Frequent stomach problems?
24. Had problems with diarrhea/constipation?
25. Have problems with sleepwalking?
26. If female, have an abnormal menstrual history?
27. Have a history of bed-wetting?
28. Ever had an eating disorder? 29. Ever had emotional difficulties for which professional help was sought?
Please explain any “yes” answers, noting the number of the question: ____________________________________________________________________________
Diseases (If yes, please check all that apply) Which of the following has the participant had?
Measles German Measles Chicken pox
Hepatitis A Mumps
Hepatitis B Tuberculosis Hepatitis C Date of last tetanus shot____________
List other diseases or give details of above ______________________________________________________________________________________
Recent exposure to a contagious disease (describe & give date) _____________________________________________________________________
*Operations or serious injuries (describe & give dates) ______________________________________________________________________________
Are immunizations up-to-date? __________ If no, explain ________________________________________________________________________
March 2016 3. Form HH, Page 1/3
Date
Attending: June 20-24
GENERAL HEALTH HISTORY 2016 Missions Adventure Camp
PLEASE PRINT: MUST BE MAILED to Alabama WMU 2 weeks prior to arrival
Any swimming, or activity limitations Yes No Describe: _________________________________________________________________
Any special medical or dietary regime to be continued? Yes No Describe: _______________________________________________________ Any specific activities to be encouraged? _________________________________Restricted? _______________________________________________ Family Physician_____________________________________________ Phone (___) __________________________________________
Dentist/Orthodontist __________________________________________ Phone (___) __________________________________________ Health related suggestions for camp personnel __________________________________________________________________________________ ________________________________________________________________________________________________________________________ Each child will be checked for head lice during registration. If lice are confirmed, there are two options for treatment listed on the “things to know” page. Once treated, the child may resume camp activities. In case of emergency and parent cannot be reached notify: ___________________________________________________________
Relation: __________________________________ Home Phone (____) ____________________________
Work Phone (____) _________________________ Cell Phone (____) ____________________________
Over-the-Counter Medications
IS PERMISSION GIVEN to administer over-the-counter medication if deemed necessary by the camp nurse? Yes No
The following is a complete list of over-the-counter medications available at WorldSong Missions Place to treat temporary discomforts
that might occur.
Please check any medication you DO NOT want given to your child during their stay at camp:
PHOTOCOPY OF FRONT AND BACK OF HEALTH INSURANCE CARD MUST BE ATTACHED TO THIS FORM INSURANCE (Fill out Below) NO INSURANCE Name of Policy Holder ________________________________________________________________ (_______) _______________________
Last First Middle Phone Address of Insured ________________________________________________________________________________________________________________
Address City State Zip Contract/Policy Number ________________________ Group Number ___________________
_________________________________________________________________________________________________________________________ Address City State Zip
Permission for Emergency Treatment and Release I hereby give permission to the Missions Adventure Camp Director or Camp Administrator, or staff member designated by him or her, to secure emergency medical treatment for my child. I do release staff, WorldSong Missions Place and Alabama WMU from all claims that might arise as a result of the activities in which the campers will be participating. Further, I authorize the consulted doctor and /or hospital to give emergency treatment to my child and agree to pay any expenses associated with such treatment. The Health History is correct to the best of my knowledge, and the person herein described has permission to engage in all prescribed activities except as noted.
____________________________________________________________ _________________ Signature of Parent/Guardian Date
I have witnessed the above signature:
______________________________________________________________ __________________ Witness Date March 2016 5. Form HH, Page 3/3
Camper __________________________ Church attending camp with_____________________ These persons may pick up my camper. (This person must present a valid Driver’s License to a member of the
WorldSong staff before your camper will be released). Name on form MUST match name on driver’s license.
Parent/Guardian Name(s): Mom: ________________________________________ Phone #: ____________________________ Dad: _________________________________________ Phone #: ____________________________ Guardian: _____________________________________ Phone #: ____________________________ Other Person(s) Who May pick up my camper: 1._______________________________________ Phone #: __________________________ 2._______________________________________ Phone #: ___________________________ These persons may under no circumstances pick up my camper. 1. __________________________________ 2._____________________________________
__________________________ ______________________________________________ Date Signature of Parent/Guardian
6.
FOR CAMP USE ONLY!!! Camp Staffer Checking ID: _________
Valid Driver’s License #:_____________________ Name as listed on ID: _______________________ Example: AL 1234567
Any special instructions _______________________________________________________ __________________________________________________________________________ __________________________________________________________________________ All medication should be listed. If your child takes it with food, after meals or needs other special instructions, please note. If your child has difficulty taking medication, please attach a note and explain to the nurse the best way to get the child to take the medication.
PLEASE DO NOT SEND OVER THE COUNTER PAIN RELIEVERS, STING AND ITCH MEDICINE, ANTIBIOTIC OINTMENTS AND FIRST AID SUPPLIES. THE CAMP NURSE WILL KEEP A SUPPLY OF THESE
