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Directions to King’s Lake Camp
“Dedicated to addressing social, physical, and spiritual needs and developing the
life skills of our campers .”
7:30 am Rise & Shine
8:15 am Flag Raising
8:30 am Breakfast
9:15 am Cabin Clean Up
9:30 am Cabin Activity
12:10 am Flagpole
12:20 pm Lunch
1:15 pm Rest Time
2:00 pm Chapel
3:00 pm Free Time
4:25 pm Flagpole
4:30 pm Shower Time
5:20 pm Flag Lowering
5:30 pm Dinner
6:30 pm Camp wide Activity
7:45 pm Evening Program
9:00 pm Cabin Devotions
8:45 pm 9:30 pm
Cabin Devotions & Lights Out
Our program at King’s Lake Camp is intended to help young people
develop new skills, instill a sense of self-confidence, promote positive social interactions, and discover
God’s creation.
The Salvation Army is a part of the Christian Church. Fun, captivating, age appropriate Bible instruction is included in every camping session.
All of our camps have nutritious,
USDA-approved meals and trained staff to make this one of the best weeks your child has ever had!
The Salvation Army King’s Lake Camp 3313 E. Lakeview Wasilla, AK 99654
Phone: 907-357-2501 Fax: 907-357-2325
A TYPICAL DAY AT CAMP
All camps start at 2:00pm on the first day and end after Breakfast
(about 9:15 am) on the last. No Child will be Received before
Check-In Time (2:00PM)
The Salvation Army ~ Kings Lake Camp Camper Application 2018
Registration fees vary based on CAMP length
Southeast Camp, S.A.Y. Camp, Adventure camp, Teen Camp - $175
Music camp - $240
The Salvation Army is part of the Christian Church. Fun, captivating, age appropriate Bible instruction is included in every camping session.
All our camps serve nutritious, USDA approved meals and trained staff
to make this the best week you’ve ever had!
Southeast Camp (Ages 7—12) June 11-15 This year, King’s Lake Camp is taking it’s show on the road, for a week of camp in the beautiful city of Haines, Alaska. Southeast Camp will feature a program based on scouting programs as kids will work towards earning badges while experiencing camp in an exciting new location.
Adventure Camp (Ages 7—12) June 25-29 Join us this summer for a week of active outdoor fun with swimming, archery, crafts, campfires, canoeing, and more. This is an activity focused program perfect for all interests.
Music Camp (Ages 9—17) july 7-14 For those who want to master their skill or learn the basics. Predominantly brass
instruments and vocal; percussion, timbrels, keyboard, and guitar instruction are also offered as part of
our music program. Family and friends are invited to enjoy the wonderful talent of our music camp par-
ticipants at our Camp Concert & BBQ on Saturday, July 14 at 10:30 AM.
Teen Camp (Ages 13—17) july 16-20 Looking for an escape from the humdrum of summer? Meet new friends, enjoy many activities: swim-
ming, archery, canoeing, this program is geared especially for teens who are looking for an exciting
camp experience! Also, ask your local corps officer about the opportunity to attend S.A.Y. Summit.
S.A.Y. Camp (Ages 7—12) july 23-27 A camp based on The Salvation Army scouting programs (Girl Guards, Sunbeams, and Adventure
Corps) —campers expand their knowledge of the world around them working on badges and having fun.
Items to pack for a great camp experience... Do Bring...
Sleeping bag and pillow
Clothing (socks, shorts, long pants, t-shirts, sweater, undergarments, running shoes)
Towel and Swimsuits (Prefer no bikini’s, but acceptable if you have a large T-shirt to cover up)
Toiletries (toothbrush, toothpaste, shampoo, soap, brush)
Current and necessary medications
Insect repellent and sunscreen
If you have an instrument, bring it to music camp
Do Not Bring...
Electronics including, but not limited to, cell phones, iPods, iPads, computers, video games, etc.
Any items found with campers will be held and locked away until the end of camp. Respecting the no elec-
tronics rule provides for a safe and “unplugged” camp experience.
We will not be held responsible for lost, stolen or broken items
Please return completed application, no later than two weeks prior to your camp session. Please send to your local Salvation Army Corps as directed, or
A completed scanned application can be emailed to [email protected]
AUTHORIZATION FOR CONSENT TO MEDICAL OR DENTAL CARE OF MINOR CHILD
THE UNDERSIGNED, BEING THE ____________________________________ (relationship to minor) AND THE PERSON HAVING LEGAL CUSTODY OF NAMED MINOR APPLICANT Hereby authorizes The Salvation Army, acting through any adult officer thereof, into whose care the said minor has been entrusted, in case of illness or injury, to hold my child at the camp under the care of the first aid attendant. In case of apparent serious sickness or injury, I wish to be notified and my child sent to a hospital or skilled medical aid called at once, for which I expect to pay the usual charge. I consent to any X-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care to be rendered to said minor under the general or special supervision and upon the advice of a physician and surgeon licensed under the provisions of the State Medical Practice Act or to consent to an X-ray examination, anesthetic, dental or surgical diagnosis or treatment and hospital care to be rendered to said minor by a dentist licensed under the provision of the Dental Practice Act. I also desire the Camp Administrator to do for my child as he would for his own child.
I GIVE PERMISSION for my child to attend camp. I will not hold The Salvation Army responsible for any accidents that may occur at camp or to or from camp. I understand that all reasonable precautions for health and safety are taken, and participation in all camp activities is at the camper’s own risk. I will be responsible for any medical expense incurred during the care of my child.
SIGNATURE: ______________________________________________________________ _________________ (Parent or Legal Guardian) Date
Camper Information
Name: _______________________________________________________________ Birthdate:_____ / _____ / _____
Address: _________________________________________ City: ___________________ Zip: _________________
Gender: M / F Age: ____ Grade Entering: ____ Shirt Size: (Circle One) Children’s: M L Adult: S M L XL XXL
Parents/Guardians: _________________________________________________________________________________
Parents/Guardians Email: ____________________________________________________________________________
Home Phone: _____________________ Work Phone(s): _____________________ Cell Phone: ____________________
Emergency Contact (if parents cannot be reached) _________________________________________________________
Home Phone: _____________________ Work Phone(s): _____________________ Cell Phone: ____________________
List of Adults Authorized to Pick-Up Camper: _____________________________________________________________
_________________________________________________________________________________________________
How did you hear about our King’s Lake Camp? ___________________________________________________________
PUBLICATION RELEASE FORM I hereby irrevocably grant to The Salvation Army, its successors and assigns, its agents and those by whom it is commissioned, the absolute, unrestricted and unlimited license, right, permission and consent to use and re-use, disseminate, copyright, print, reproduce, publish and republish, for any and all trade purposes or commercial or other advertising or public purposes, and in any and all advertising, publicity, display, publication or media, my name, signature and likeness, and any portraits, pictures, photographic prints or other representations of my child, or in which he/she may appear, or any reproductions or sketches thereof or parts thereof, photographic or otherwise, with such additions, dele-tions, alterations or changes therein as you in your discretion may make, either separately or together with his/her name or a fictitious name, or the name of another person, with or without any statements or testimonials made by me, or authorized by me which you may, in your discretion, prepare for use in connection therewith. I warrant that I have not limited or restricted the use of my child’s name or photograph to the use of any organization or person. I hereby release and discharge The Salvation Army, it successors, assigns and agents from any and all claims and demands arising out of or in connection with the use of any of the foregoing, including any claims for defamation, invasion of privacy or violation of any statutory right. I hereby certify that I am the (parent)/(legal guardian) of a minor child or dependent and have executed this release on (his)/(her) behalf.
SIGNATURE: ______________________________________________________________ _________________ (Parent or Legal Guardian) Date
REFUND POLICY In signing this application, I agree that after a place has been secured, the above named camper will remain for said period unless dismissed for breach of camp policy. In event of dismissal or voluntary withdrawal, there will be no refund of camp fees. If because of illness or accident, a prorated refund may be made. SIGNATURE: _______________________________________________________________ _________________ (Parent or Legal Guardian) Date
Southeast Camp
Adventure Camp
Music Camp
Teen Camp
S.A.Y. Camp
2018 King’s Lake Camp Registration Form 3313 E. Lakeview Road, Wasilla, AK 99654 Summer: (907) 357-2501 Off-Season: (907) 375-3597
Email: [email protected] Website: kingslakecamp.salvationarmy.org
Please indicate which camp your child will be attending:
June 11-15
June 25-29
July 7-14
July 16-20
July 23-27
$175
$175
$240
$175
$175
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Doct
or’
s N
am
e
D
oct
or’
s P
ho
ne
Nu
mb
er
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In
sura
nce
Co
mp
an
y
P
oli
cy N
um
ber
T
he
Cam
per
’s I
nsu
ran
ce i
s co
nsi
der
ed t
he
pri
mar
y i
nsu
rance
in
th
e ev
ent
of
an a
ccid
ent
or
hea
lth
pro
ble
m w
hil
e C
amp
er i
s at
tend
ing a
cam
p.
(Kin
g’s
L
ake
Cam
p d
oes
; h
ow
ever
, ca
rry a
ccid
ent
insu
rance
in
th
e ven
t th
ere
is n
o f
amil
y a
ccid
ent
insu
rance
.)
Ha
s th
e C
am
per
had
a p
hy
sica
l in
th
e la
st 2
4 m
on
ths?
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Ple
ase
atta
ch a
cop
y o
f p
hysi
cal
to t
his
form
. (R
ecom
men
ded
, n
ot
requ
ired
)
Ple
ase
lis
t an
y s
pec
ial
lim
ita
tion
s or
rest
rict
ion
s (e
g.
Die
t, g
lass
es/c
on
tact
s, r
etai
ner
s, h
eari
ng a
ids,
sle
epw
alk
ing,
bed
wet
tin
g, m
edic
al d
evic
es i
n u
se, hosp
ital
izat
ion
s or
surg
erie
s, h
om
e si
ckn
ess,
soci
aliz
atio
n i
ssu
es, et
c)
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ME
DIC
AT
ION
S (
Lis
t w
ith
in
stru
ctio
ns)
N
ote
: A
ll p
resc
rip
tion
med
icat
ion
s m
ust
car
ry P
har
mac
ist’
s la
bel
and
be
in o
rigin
al
con
tain
ers.
All
med
icat
ion
s w
ill
be
kep
t se
cure
by t
he
cam
p’s
Hea
lth C
are
Pro
vid
er a
nd
mad
e av
aila
ble
as
pre
scri
bed
. C
amp
ers
may
not
bri
ng o
ver
-th
e-c
ou
nte
r m
edic
atio
ns,
un
less
th
ey h
ave
wri
tten
in
stru
ctio
ns
from
a l
icen
sed p
hysi
cian
. O
ver
-th
e-co
unte
r m
edic
atio
ns
wil
l b
e m
ade
avai
lab
le b
y t
he
cam
p’s
Hea
lth
Car
e P
rovid
er a
ccord
ing t
o w
ritt
en, h
ealt
h-c
are
poli
cies
an
d p
roce
du
res.
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PA
RE
NT
/GU
AR
DIA
N A
UT
HO
RIZ
AT
ION
I au
thori
ze t
he
above-
nam
ed m
inor
to f
ull
y p
arti
cip
ate
in t
he
cam
p t
hey
are
reg
iste
red
for,
un
less
res
tric
tion
s ar
e note
d a
bove.
Th
e m
inor
may
be
tran
sport
ed i
n c
amp –
des
ignat
ed v
ehic
les
for
off
-sit
e tr
ips
and f
or
emer
gen
cy a
nd r
ou
tin
e m
edic
al c
are.
I g
ive
per
mis
sion
to s
earc
h c
amp
er
bel
on
gin
gs
wit
h t
he
cam
per
pre
sen
t w
hen
th
e h
ealt
h, w
ell-
bei
ng,
or
safe
ty o
f th
e ca
mp
er o
r oth
ers
req
uir
es i
t.
I
her
eby g
ive
per
mis
sion
to t
he
med
ical
per
son
nel
sel
ecte
d b
y t
he
cam
p d
irec
tor
to p
rovid
e ro
uti
ne
hea
lth c
are;
to a
dm
inis
ter
med
icat
ion
s (p
resc
ripti
on a
nd o
ver
-th
e-co
un
ter)
; to
ord
er X
-ray
s, r
ou
tin
e te
sts,
an
d/o
r tr
eatm
ent;
to r
elea
se a
ny r
ecord
s n
eces
sary
fo
r in
sura
nce
pu
rpose
s; a
nd t
o
pro
vid
e or
arra
nge
nec
essa
ry,
rela
ted
tra
nsp
ort
atio
n f
or
me
or
the
above-n
amed
min
or.
In
th
e ev
ent
I ca
nn
ot
be
reac
hed
in
an e
merg
ency,
I h
ereb
y g
ive
per
mis
sion t
o t
he
ph
ysi
cian
sel
ecte
d b
y t
he
cam
p d
irec
tor
to s
ecu
re a
nd
ad
min
iste
r tr
eatm
ent,
in
clud
ing h
osp
ital
izat
ion
, fo
r th
e m
inor
nam
ed a
bove.
T
his
com
ple
ted
form
may
be
ph
oto
cop
ied f
or
trip
s out
of
cam
p.
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Pri
nt
Nam
e
R
elat
ionsh
ip t
o C
am
per
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/__
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_/_
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Sig
nat
ure
D
ate
KI
NG
’S L
AK
E C
AM
P 2
01
8 H
EA
LT
H F
OR
M
CO
MP
RE
HE
NS
IVE
HE
AL
TH
HIS
TO
RY
PH
YS
ICIA
N I
NF
OR
MA
TIO
N
E
ME
RG
EN
CY
AU
TH
OR
IZA
TIO
N
(Ple
ase
no
te:
Duri
ng c
hec
k-i
n o
n r
egis
trat
ion d
ay t
her
e w
ill
be
a “h
ealt
h s
cree
nin
g”
wh
ere
the
cam
p w
ill
chec
k t
he
Cam
per
fo
r li
ce,
ask f
or
all
med
icat
ions
to b
e tu
rned
in,
ask a
bo
ut
any
rece
nt
inju
ries
, exp
osu
re t
o c
om
mu
nic
able
dis
ease
s, a
nd
if
ther
e have
bee
n a
ny c
han
ges
in
Cam
per
’s h
ealt
h/u
sage
of
med
s si
nce
co
mp
leti
on o
f th
is f
orm
)
Ca
mp
er N
am
e: _
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C
amp
er’s
Fu
ll N
ame
(las
t, f
irst
—le
ase
ente
r n
ame
as e
nte
red
on
reg
istr
atio
n f
orm
)
Ple
ase
pro
vid
e dat
es (
mo/y
r) o
f all
im
muniz
atio
ns
or
a co
py o
f th
e C
am
per
’s r
ecord
s:
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_/_
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___
_
D
PT
Ser
ies
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___
_/_
__
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___
_
P
oli
o
____
___
___
_/_
__
___
___
_
M
MR
(M
easl
es/m
um
ps/
rub
ella
) _
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___
_/_
__
___
___
_
T
ub
ercu
lin
tes
t _
___
___
___
_/_
__
___
___
_
T
etan
us
boost
er
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___
_/_
__
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_
H
epat
itis
B
____
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___
_/_
__
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_
H
aem
phil
us
Infl
uen
za (
HIB
) _
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_/_
__
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O
ther
My c
hil
d h
as o
r h
as h
ad t
he
foll
ow
ing:
All
erg
ies/
Die
tary
Res
tric
tio
ns:
If
chec
ked
, p
leas
e sp
ecif
y (
eg.
Hay
Fev
er,
Pois
on
Oak
/Iv
y,
Inse
ct S
tin
gs,
P
oll
en,
Pen
icil
lin
, or
spec
ific
food
s, d
rugs,
or
oth
er):
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_
Neu
ro/P
sych
olo
gic
al:
If
chec
ked
, p
leas
e sp
ecif
y (
eg.
AD
D/A
DH
D,
Ep
ilep
sy,
Con
cuss
ion,
Con
vu
lsio
ns,
etc
):_
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____
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_
Dis
ease
s:
If
chec
ked
, p
leas
e sp
ecif
y (
eg.
Chic
ken
Pox, M
easl
es,
Ger
man
Mea
sles
, M
um
ps,
Sca
rlet
Fev
er,
etc)
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_
Oth
er:
If
chec
ked
, p
leas
e sp
ecif
y (
eg.
Rheu
mat
ic F
ever
, F
ain
tin
g, D
iab
etes
, A
sth
mas
, A
IDS
, et
c):_
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Privacy Act Statement: This explains how we will use the information you give us. The Richard B. Russell National School Lunch Act requires the information on this application. You do not have to give the information, but if you do not, we cannot approve your child for free or reduced price meals. You must include the social security number of the adult household member who signs the application. The social security number is not required when you apply on behalf of a foster child or you list a Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF) Program or Food Distribution Program on Indian Reservations (FDPIR) case number or other FDPIR identifier for your child or when you indicate that the adult household member signing the application does not have a social security number. We will use your information to determine if your child is eligible for free or reduced price meals, and for administration and enforcement of the lunch and breakfast programs. We MAY share your eligibility information with education, health, and nutrition programs to help them evaluate, fund, or determine benefits for their programs, auditors for program reviews, and law enforcement officials to help them look into violations of program rules. Non-discrimination Statement: This explains what to do if you believe you have been treated unfairly. “In accordance with Federal law and U.S. Department of Agriculture policy, this institution is prohibited from discriminating on the basis of race, color, national origin, sex, age, or disability. To file a complaint of discrimi-nation, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410 or call (800) 795-3272 or (202) 720-6382 (TTY). USDA is an equal opportunity provider and employer.”
Help us receive our 2018 USDA grant. Income Eligibility Form for Summer Food Service Program PART 1. All Household members *If ALL children listed below are foster children, complete Part 1, then skip to Part 6 to sign this form.
Names of ALL household members (First, Middle Initial, Last)
Name of School Age Foster Child
Check if approved for PFD in 2017
PART 2. Benefits If any member of your household receives SNAP/Food Stamp or ATAP/TANF, provide the name and case number for the person who receives benefits and skip to Part 6. If NO ONE receives these benefits, skip to Part 3. Name: Case Number: PART 3. Check if this application is for a child who is enrolled in Early Head Start or Head Start. Skip to Part 6.
PART 4. Check if this application is for a child who is homeless, migrant, or a runaway. Skip to Part 6.
PART 5. Total Household Gross Income. You must tell us how much and how often.
Name (List ALL adults and children in the household with income.)
Gross income how often it was received ( Annual; Weekly; Every 2 Weeks; Twice A Month or Monthly)
Earnings from Work before deductions
Welfare, Child support, Alimony
Pensions, Retire-ment, Social Security
All Other In-come
(Example) Jane Smith $200/ Weekly $150/ Every 2 weeks $100 / Monthly $2,500/ Annu-
$_______/______ $_________/________ $________/______ $______/____
$_______/______ $_________/________ $________/______ $______/____
$_______/______ $_________/________ $________/______ $______/____
$_______/______ $_________/________ $________/______ $______/____
$_______/______ $_________/________ $________/______ $______/____
$_______/______ $_________/________ $________/______ $______/____
PART 6. Signature and Last Four Digits of SSN (An adult household member must sign the application.)
If Part 5 is completed, the adult signing the form also must list the last four digits of their Social Security Number or mark the “I do not have a Social Security Number” box. (See Privacy Act Statement on the back of this page.)
I certify (promise) that all information on this application is true and that all income is reported. I understand that the school will get Federal funds based on the information I give. I understand that school officials may verify (check) the information. I understand that if I purposely give false information, my children may lose meal benefits, and I may be prosecuted. Sign here: Print name: Date: __________
Address: Phone Number: City: State:____ Zip:
PART 7. Children’s Ethnic and Racial Identities (Optional)
Choose one ethnicity: Choose one or more (regardless of ethnicity):
Hispanic/Latino Not Hispanic/Latino
Asian American Indian or Alaska Native Black or African American White Native Hawaiian or other Pacific Islander
