Wooten Registration Form 2018

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Summer Blast at Camp Wooten 2018 Registration

Summer Blast is a 5 day over-night camp for kids who will enter grades 3rd-6th t h i s fall (campers must be at least 8 years old by July 1, 2018). The program is cooperatively organized and run by various churches of the Pacific Northwest Christian & Missionary Alliance. Our all-volunteer staff is made up of Christian adults who have been individually qualified through an application process and background check. Each is committed to make this camp experience safe and meaningful for every one of our campers. It is our desire to share with them the reality of our faith in the context of a camping program designed with them specifically in mind. Our location is CAMP WOOTEN, an Environmental Learning Center established by Washington State ’s Parks and Recreation Commission for the purpose of providing youth with a place to enjoy nature and to study the environment. Located on the Tucano River in the beautiful surroundings of the Blue Mountains, Camp Wooten has safe hiking trails, an in- door swimming pool, tennis, volleyball and basketball courts, ball fields, and a small lake.

NAME OF CAMPER AGE FALL

BIRTHDATE FEMALE

MALE

GRADE NEXT

(must be 3rd - 6th)

ADDRESS CITY

STATE

ZIP CODE

PARENT/GUARDIAN #1

CONTACT PHONE/CELL

PARENT/GUARDIAN #2

CONTACT PHONE/CELL

EMAIL EMERGENCY CONTACT (Other than Parent/Guardian)

PHONE

Church Affiliation (if any):

Check out our website at

http://summerblastcma.wixsite.com/camp

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Bible Flashlight Great Attitude Insect Repellant Light Jacket Notebook Pen or Pencil Personal Grooming Items Pillow River Shoes Sun Block Sleeping Bag and fitted twin sheet Swimsuit Towels for swimming/bathing

Please let us know… if your child has any special concerns or considerations we need to be aware of:

~Early Registration/Payment due by June 16th Late registrations will incur a $35 late fee. >>No registrations accepted after: July 14th<<    

Matches/Lighters Knives Handheld Games/iPods Food/ Candy/ Gum

PAYMENT ENCLOSED: $

Today’s Date:

*Make this registration check payable to: (Received by:

Summer Blast Date:

*Church Attending With: NAME

AGE

BIRTHDATE

Sat. July 28 through Wed. August 1, 2018

WEIGHT

ALLERGIES INSURANCE PROVIDER

POLICY #

$ 190.00 by June 16

NAME OF INSURANCE HOLDER:

$ 225.00 By July 14th

GENERAL MEDICAL & EMERGENCY AUTHORIZATION: (Initials on each line are required for your child’s participation)

I give permission to the camp nurse/physician to administer this camper’s routine medications and ‘as needed’ medications/over the counter medications for minor illness or discomfort. In the event I cannot be reached in an emergency, I also give permission to the physician selected by the camp director to provide routine and/or heroic medical treatment, according to standard medical procedure, for the above-named camper. I give permission for my child to participate in all sporting and camp events and absolve the camp from reimbursement in the event of personal injury. In the event of minor headaches or bug bites, do you give the nurse permission to give your child Tylenol or Benadryl? Yes No

“The Lion and the Lamp-post” Return registration and payment to at Contact phone

This camper is able and has permission to swim independently, in a group setting, under the supervision of a certified lifeguard. Yes No

MEDICATIONS: Please list all routine medications, including non-prescription/over the counter drugs. Send with your camper (ONLY enough to last the entire time at camp) all medications in original packaging and, for prescription, that identifies the prescribing physician. Clearly mark your camper’s name on all containers and send in a marked zip-lock bag. Please provide the following information for each medication to be given: MEDICATION #1

DOSAGE

TIME(S) TO BE TAKEN (indicate) EACH DAY/AS NEEDED: REASON FOR MEDICATION MEDICATION #2

DOSAGE

TIME(S) TO BE TAKEN (indicate) EACH DAY/AS NEEDED: REASON FOR MEDICATION Attach additional paper for medications #3, #4, etc.

Email

What you will do at Summer Blast:           

Basketball Canoeing Crafts Fantastic Food Group Games Hiking Guided Walks Group Recreation River Tubing Swimming Volley Ball

Campfire Time  Fun Songs  Stories  Snacks  Cabin Participation Teaching  Bible-based  Encouraging  Our Speaker: Mike Wallace

REQUIRED FOR ASTHMATICS: (You must initial one) I give my child permission to carry and self-administer his/her own albuterol rescue inhaler. I prefer the camp nurse keep my camper’s inhaler and to help my camper determine when it is needed.

PARENT/GUARDIAN SIGNATURE (Required)

DATE

Your camper loves to receive mail!! Please pre-send 3 letters/small packages for your child to receive during his/her stay away from home. Mark each letter with the day of the week it is to be delivered. Your church will collect mail, to deliver in bulk, on this date: