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7/28/2019 Kids Camp Application 2013
http://slidepdf.com/reader/full/kids-camp-application-2013 1/2
2013 Children's Camp Application
Camper's Full Name
Address:
Health / Medical Information
Physician's Name:
Phone # (_ )_ -
Name of Insurance Carrier:
Group Name / Number
Policy Number
Special Physical / Medical Needs:
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 Church
1.)
2.)
3.)
4.)
No changes will be made at camp!!
I hereby authorize medical treatment to the above
named camper in the event of i llness or accident
during the East Tennessee District Children's
Camp, held Monday June 10 thru Friday, June 14,2013
"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 t o the person or
property of the above named camper in connection with
or incident to East Tennessee District Children's Camp "
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
Adult sizes
small medium large x-large
For Office Use Only
Dorm:
CityState Zip Code
Phone(_ )_ -
Date of Birth / / Age:
Grade Completed:
S.S.# - -_
Male Female
Name of Parent / Guardian
Relationship to Camper_
Phone(_ )_ -
Alt. # ( )_ -
Address:
City
State Zip Code
Church you attend
Church # (_ )_ -
Address:
City
State Zip Code
Pastor Name
7/28/2019 Kids Camp Application 2013
http://slidepdf.com/reader/full/kids-camp-application-2013 2/2
2013 Children's Camp Application
Camp Cost $150.00
1st
grade-6th
grade
Send Application to: Coordinator Contacts:
John & Melinda Hale Melinda : 423-765-7569 [email protected]
1402 Sevier Terrace Drive John: 423-429-8420 [email protected]
Kingsport, Tn. 37660 Melissa Wilson: 931-224-6139 [email protected]
Must be postmarked by:
May 13th
or $20.00 late fee will apply
Make Checks payable to: ETN Dist SDMI
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 & Security1. A camp telephone is available for
emergencies only. Any cell phone
brought to camp is theresponsibility of the camper and is
not to be used during camp
activities.
2. Parents/guardians may call or text
the camp coordinators at any time.
3. All rooms and personal items are
subject to be searched.
4. All visitors must notify the camp
directors upon entering camp
property.5. All campers must be in dorms and
accounted for at lights out.
6. No camper is to be outside the
dorm for any reason after this time.
7. Do not send money with child.
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.
Packing List
1. Bible
2. Soap, shampoo, toothbrush,
toothpaste, and hygiene items.
3. Towels & washcloths
4. Sleeping bag, sheet, pillow &
blanket.
5. Clothes…including socks, shoes
and swimsuit.
6. Last but not least….A Great &
Positive Attitude!!
Camp RegistrationLocated 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.