2013 Children's Camp Application

Health / Medical Information Physician's Name: Camper's Full Name Address: City State Phone(_ )_ Phone # (_ )_ I hereby authorize medical treatment to the above named camper in the event of illness or accident during the East Tennessee District Children's Camp, held Monday June 10 thru Friday, June 14,2013

Name of Insurance Carrier: Zip Code Group Name / Number Policy Number Age: Special Physical / Medical Needs:

"I hereby validate with my signature this registration form and do expressly waive any and all claims against the East Tennessee District Church of the Nazarene and / or its Board and / or any of its representatives, because of illness, injury, or damage to the person or property of the above named camper in connection with or incident to East Tennessee District Children's Camp "

Date of Birth / / Grade Completed: S.S.# -_ Male Female

Name of Parent / Guardian Relationship to Camper_ Phone(_ )_ Alt. # ( )_ Address: City State

Medication taken regularly (Please list on separate piece of paper - send with child to camp. Please have meds labeled and in zip lock baggies with child's name, amount and times to be taken on the bag.) Allergies: Date of last Tetanus Shot / /
Room mates (Please list who you would like to room with and add their church Name
1.) 2.)

Signature of Parent / Guardian Date: / /

ALL REGISTRATIONS
MUST BE NOTARIZED / / Notary's Signature Date
Expiration Date of Commission / /

Please include Shirt Size Circle one

Children's sizes x-small small medium large

Zip Code

Church # (_ Address: City State Pastor Name

Church you attend )_ -

Church

Adult sizes small medium large x-large

Zip Code

3.) 4.) No changes will be made at camp!!

For Office Use Only

Dorm: Paid

Due

2013 Children's Camp Application

Camp Cost $150.00 1st grade-6th grade

Send Application to: John & Melinda Hale 1402 Sevier Terrace Drive Kingsport, Tn. 37660 Must be postmarked by: May 13th or $20.00 late fee will apply Make Checks payable to: ETN Dist SDMI Coordinator Contacts: Melinda : 423-765-7569 melinda1102@gmail.com John: 423-429-8420 pastorjohnhale@gmail.com Melissa Wilson: 931-224-6139 tmwilson_4@yahoo.com

Camp Guidelines 1. No fireworks, firearms, paint ball guns, spray paint, knives, tobacco, drugs or alcohol. Violators will be sent home. 2. No electronic equipment allowed. These devices distract campers. 3. Mattresses should be covered with a sheet even if a sleeping bag is used. 4. Campers and Counselors are asked to dress modestly & shoes must be worn at ALL times. Unacceptable Items include: short shorts, low cut tops & two piece swim suits that do not cover abdomen. 5. Please do not send good clothing that may be ruined or left behind and place name and church on all items.

Telephone & Security

1. A camp telephone is available for emergencies only. Any cell phone brought to camp is the responsibility of the camper and is not to be used during camp activities. Parents/guardians may call or text the camp coordinators at any time. All rooms and personal items are subject to be searched. All visitors must notify the camp directors upon entering camp property. All campers must be in dorms and accounted for at lights out. No camper is to be outside the dorm for any reason after this time. Do not send money with child.

2. 3. 4.

Packing List 1. Bible 2. Soap, shampoo, toothbrush, toothpaste, and hygiene items. 3. Towels & washcloths 4. Sleeping bag, sheet, pillow & blanket. 5. Clothesincluding socks, shoes and swimsuit. 6. Last but not least.A Great & Positive Attitude!! Camp Registration Located in the conference center below the hotel. Monday 1pm-4pm (EST) No Early Registrations/No Exceptions. Departure Noon dismissal from Tabernacle. Please copy this form for at home use while your child is at camp.

5. 6. 7.

A pastor and/or parent will be contacted if a child is in violation of Camp rules and the child will be sent home at the expense & inconvenience of the parents.