June 16-19

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Medical Information ALLERGIES: _____________________________________________________________________________ (food or medications) IMMUNIZATIONS Current?: Yes No If No, please explain: ___________________________________________________________________________________________________________ Last Tetanus Shot:: ______________________________ MEDICAL PROBLEMS or RECENT ILLNESS, or SPECIAL INSTRUCTIONS? (Please describe): ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ MEDICATIONS: Please list ALL medications taken, prescription and over the counter on the enclosed Medication form and bring to camp with the child. Pack the medications and this information separately so it can be turned in to the camp nurse upon arrival. Please note that all medications must be in their original container. Bag all medications in a large baggie with the Medication Form for the nurse.

Do you give permission for the camp nurse to administer: Tylenol Yes

No

Ibuprofen/Advil Yes

Benadryl Yes

No

No

Is your child able to participate in all recreational activities? If NO, please explain: _________________________________________________________________________ Name:

IN CASE OF AN EMERGENCY, NOTIFY: ___________________

Home Phone: __________________________ Health Insurance Agency: Policy number:

Cell: _____________________________ ______

____

Group number:

__________

Release of Liability and Claims

(camper’s name) has my permission to engage in prescribed activities, except as noted by me. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by an adult leader in charge, to order injection, surgery or any other medical treatment that may be deemed necessary to insure the well-being of the above named, due to sickness or accident while attending First Kid’s Camp at Camp Copass in Denton, Texas. I also authorize the camp personnel or adult counselors to transport my child at their discretion in case of an emergency. We represent to you that we and the participant hold the camp, its agents, employees and representatives and First United Methodist Church of Carrollton, its agents, employees and representatives members, agents and volunteer camp workers from any and all liability, claims, damages, losses, and causes of action of whatever kind, arising directly or indirectly from or during my child’s participation in camp activities, be they formal or informal, and/or from my child’s transportation to and from such activities, and (2) to maintain at my own expense adequate medical and hospitalization insurance coverage for said child, and (3) to bear sole financial responsibility for all injuries, medical care and other costs relating to my child arising from any accident at or during any camp activities, including transportation provided to or from such activities. Parents’/Guardians’ Signature: ___________________________________________________ Print full name:

Date: _____________________________

*my signature also gives my permission for my child to appear in any photos or videos made at the camp for future promotion of FIRST Kid’s Camp.

June 16-19 Camp Copass Denton, Texas 76208

To Register: Complete both sides of the Registration Form.

It Happened at Night

Discuss any physical handicaps or medication needs your child has with the camp nurse at drop off. ALL MEDICINES MUST BE TURNED IN AT DROP OFF. Detach and mail your payment to:

At camp, we’ll look at some really cool stories in the Bible that happened at night. From these stories, we can learn how God worked in people’s hearts to change them to become better. We can find our hearts changed, too! * * * * Camp is open to any child who will be entering Third, Fourth, Fifth or Sixth Grade in this coming school year. Children will be assigned to cabin groups according to grade level. Cost for Camp: $225.00 ($250 if paid after June 1) includes meals, lodging, all recreation and camp t-shirt! If you need to pay in installments, you can do so as long as the entire fee is paid in full by camp time.

Transportation to camp is not provided. It is the responsibility of the parent(s) to get         

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Bring to Camp: Bible and Pen or Pencil Flashlight Dirty Clothes Bag Money for Snack Bar Pillow, Towel, and Washcloth Casual clothes for 4 days Swimming Suit and Towel (Girls, one piece suit) Sheets/Blanket for Twin Bed or Sleeping Bag Personal Care items (soap, toothbrush, toothpaste, deodorant, comb, etc.) Do Not Bring:

cell phones Electronic games or ipods Knives or sharp objects

Cindy Johnston First United Methodist Church 2201 E. Hebron Parkway

Carrollton, TX 75010 (469) 568-1240

First kids Camp Registration Price increases on June 1, 2014

PLEASE PRINT

Camper’s Name:

Goes by:

Address: Sex:

City, Zip: Grade entering:

Birthdate:

Phone:

Parent’s or Legal Guardian’s Name: Parent’s Cell Phone:

Parent’s E-mail:

Church Camper Attends: Is this the first camp this child has attended?

If not, when?

Does camper swim? T-Shirt size (included in registration) Circle size needed: Youth-S (6-8) Youth-M (10-12) AMOUNT ENCLOSED: $225.00 (Office use only) Date Received:

Youth-L (14-16)

Adult-S

Adult-M

Adult-L

(If paid after June 1- $250.00) Amt. Pd:

Chk No: