Vietnam Camp Registration

Vietnam Camp

Dates and times

Thursday, June 23- Saturday, June 25, 2022
Camp is from 9:30 AM to 3:30 PM each day of camp.

Location

South Tulsa Baptist Church

10310 S. Sheridan Rd., Tulsa, OK

Who is invited
- Campers between the ages of 4 (by August 1, 2022) to 6th grade completed.
- Junior high students who have completed 7th and 8th grade.
- Adults are encouraged to volunteer and attend workshops.
- Nursery is available for younger children.
- High school students have fun volunteering as teen counselors!
Activities for everyone
- Learning about Vietnam
- Making new friends
- Parents enjoy attending workshops and fellowship with other families.
- Friday evening is Family Night. More details will be sent later. This evening event is free.
- Saturday will conclude with a special program presented by the campers!
- Enjoy shopping? Our camp store will sell items from Vietnam
Cost

At Dillon International, It is incredibly important to us that the heritage camps we provide are high quality, affordable camps. We’ve worked hard to ensure the cost of camp has been able to remain the same for over five years. However, due to rising supply costs we have had to come to the difficult decision that all camp fees will need to increase by $15 per person for the 2022 camp season.

We recognize that the past two years have been difficult financially for many families, and never want cost to be the reason a family is unable to attend camp. We will still be offering a 50% discount for any camper whose parent volunteers to be a classroom teacher, as well as a $30 early bird discount for any registrations submitted prior to March 31st. Additionally, there is also a partial scholarship program available to any family who would benefit from further assistance. For information about camp scholarships, please email marcia@dillonadopt.com.
- $175 per camper
- $100 per junior high student
- $100 per high school student
- $75 per Parent Package
Parents, we need you!

The success of camp depends on parent volunteers. Please consider volunteering. Click here for the camp volunteer application form. We will contact you in 1-2 weeks after you submit the form. A separate application is required for each adult volunteer.

Questions?

We are here to serve you. Email rfloyd@dillonadopt.com or call us at 918-749-4600.
Vietnam Camp Registration
Parent name *

First Name Last Name
Cell phone *

Area Code Phone Number
Parent name

First Name Last Name
Additional phone

Area Code Phone Number
How would you prefer to be contacted if we need to get in touch with you while your child is at camp? *

Text Phone Call
If you opt to receive text messaging, you will only be messaged by authorized personnel of Dillon International, Inc. No purchase is required to receive text messages from Dillon International, Inc., and we do not charge to receive them. However, standard text messaging rates from your wireless carrier may still apply. Any costs related with receiving a text message are the responsibility of the individual receiving it. Check with your cellphone provider for details on receiving text messages (SMS).
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
E-mail *
Include my address, phone number and e-mail to be compiled into a Camp Directory for other camp families to see. *

Yes No
How did you hear about Dillon's Vietnam Camp? *
Camper (4 years old by August 1st - 6th grade completed)

If you do not have any campers, please scroll to the next section (Jr. High Student).
Camper 1
First Name Last Name
Gender
Years attended camp
Date of Birth

Month Day Year
Country of Birth
Province/City of Birth
Adopted through Dillon?

Yes No
Grade completed
Adoption Year (Leave blank if N/A)
T-shirt size
If you would like your child to be in the same class as another child who is the same age, you may list the name of one camper. Keep in mind that we cannot guarantee placement together, but we will do our best to accommodate.
Camper 2
First Name Last Name
Gender
Years attended camp
Date of Birth

Month Day Year
Country of Birth
Province/City of Birth
Adopted through Dillon?

Yes No
Grade completed
Adoption Year
T-shirt size
If you would like your child to be in the same class as another child who is the same age, you may list the name of one camper. Keep in mind that we cannot guarantee placement together, but we will do our best to accommodate.
Camper 3
First Name Last Name
Gender
Years attended camp
Date of Birth

Month Day Year
Country of Birth
Province/City of Birth
Adopted through Dillon?

Yes No
Grade completed
Adoption Year
T-shirt size
If you would like your child to be in the same class as another child who is the same age, you may list the name of one camper. Keep in mind that we cannot guarantee placement together, but we will do our best to accommodate.
Camper 4
First Name Last Name
Gender
Years attended camp
Date of Birth

Month Day Year
Country of Birth
Province/City of Birth
Adopted through Dillon?

Yes No
Grade completed
Adoption Year
T-shirt size
If you would like your child to be in the same class as another child who is the same age, you may list the name of one camper. Keep in mind that we cannot guarantee placement together, but we will do our best to accommodate.
Jr. High Students (completed 7th & 8th grade)

If you do not have any Jr. High students, please scroll to the next section (High School Students).
Hanoi Program: In this program your Jr. High student will be able to continue being a participant at camp. As a Hanoi Program participant, your student will be able to spend more time with friends, do a few adoption and identity activities, and more in-depth cultural classes. The cost of this program will be $100 per participant.
Jr. High Student 1
First Name Last Name
Gender
Years attended camp
Date of Birth

Month Day Year
Country of Birth
Province/City of Birth
Adopted through Dillon?

Yes No
Grade completed
Adoption Year
T-shirt size
If you would like your child to be in the same class as another child who is the same age, you may list the name of one Jr. High student. Keep in mind that we cannot guarantee placement together, but we will do our best to accommodate.
Jr. High Student 2
First Name Last Name
Gender
Years attended camp
Date of Birth

Month Day Year
Country of Birth
Province/City of Birth
Adopted through Dillon?

Yes No
Grade completed
Adoption Year
T-shirt size
If you would like your child to be in the same class as another child who is the same age, you may list the name of one Jr. High student. Keep in mind that we cannot guarantee placement together, but we will do our best to accommodate.
High School Students (completed 9th through 12th grade)

High school students have the opportunity to participate in the high school program at camp. They will be able to participate in some of the jr. high classes, as well as take on a leadership role for younger campers. If you do not have any teen counselors, please scroll to the next section (Special Considerations and Parental Consent). The cost is $100 per high school student participant.
High School Student 1
First Name Last Name
Gender
Years attended camp
Date of Birth

Month Day Year
Country of Birth
Province/City of Birth
Adopted through Dillon?

Yes No
Grade completed
Adoption Year
T-shirt size
If you would like your teen to be in the same class as another teen who is the same age, you may list the name of one teen. Keep in mind that we cannot guarantee placement together, but we will do our best to accommodate.
High School Student 2
First Name Last Name
Gender
Years attended camp
Date of Birth

Month Day Year
Country of Birth
Province/City of Birth
Adopted through Dillon?

Yes No
Grade completed
Adoption Year
T-shirt size
If you would like your teen to be in the same class as another teen who is the same age, you may list the name of one teen. Keep in mind that we cannot guarantee placement together, but we will do our best to accommodate.
Special Considerations and Parental Consent
Please explain any allergies or special dietary needs (food, medicines, insects, plants, etc.) for any participants or teen volunteers listed.
Please explain any medical needs, intellectual disabilities, restrictions in activities or other challenges we need to be aware of or accommodate.
If your child(ren) will need one-on-one care, please specify.
Participation Agreement

I give full permission for my child(ren) to participate in the activities while at Dillon International’s Heritage Events conducted by Dillon International, Inc.,("Dillon") on June 23, 24, and 25, 2022. I fully and unconditionally release, remise, discharge and hold harmless Dillon (including its parent entities, affiliates, their current and former officers, directors, members, agents and employees), together with South Tulsa Baptist Church and providers of services, host and volunteers from any and all claims, charges, complaints, demands, actions, causes of action, suits, damages, liabilities and expenses (including attorneys’ fees) however caused, that might arise from my child(ren)’s participation in camp.

Photo Release

I hereby authorize Dillon International to use pictures of myself or my child(ren) taken in a photograph, digital image, videotape, motion picture, and/or testimonial (written words). I grant permission to use a camper’s photograph or other media for display on the Dillon website, social media account, and/or inclusion in Dillon publications. I understand that Dillon will not put any identifying information in the photo or video.

COVID-19 Waiver

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious.

I recognize that while Dillon International has undertaken reasonable steps to lessen the risk of transmission of COVID-19 in connection with attendance at Dillon International’s Heritage Events, there are certain inherent risks associated with attending Dillon International’s Heritage Events regarding COVID-19.

On my behalf and on behalf of my child(ren), I hereby release, covenant not to sue, discharge, and hold harmless Dillon International and South Tulsa Baptist Church, their employees, agents, volunteers and representatives from all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating to Dillon International’s Heritage Events. I understand and agree that this release includes any claims based on the actions, omissions, or negligence of Dillon International and South Tulsa Baptist Church, their employees, agents, volunteers and representative whether a COVID-19 infection occurs before, during, or after participation in Dillon International’s Heritage Events.

COVID-19 Disclosure Agreement

I willingly agree to contact Dillon International if any camp participant included in this application begins displaying symptoms of COVID-19 or receives a diagnosis of COVID-19 within 14 days of being present at Dillon International’s Heritage Events. I understand a 24-hour phone number will be provided to me by Dillon International for this purpose. I further understand that this information is to be used for contact tracing purposes only, and that the affected individual’s identifying information will be kept confidential and will not be shared with other camp participants.

Signature

I have read, fully understand and consent to the terms and liability release in the above participation agreement, photo release, COVID-19 waiver, and COVID-19 disclosure agreement.
*

Clear
Adult Volunteers

If you are planning to volunteer, you will receive the link to a volunteer application after you click Submit at the end of this registration form.
Please add $7 to my total to help Dillon with the cost of my volunteer background check. (Any contributions are greatly appreciated, but this is in no way required to volunteer with us.)
Participant Fees

The participant fee includes lunches, snacks, T-shirt, group photo and activities. Multi-child and parent volunteer discounts apply. If you would like to apply for a partial scholarship, please email development@dillonadopt.com.
Camper Fee

1 Camper: $175 2 Campers: $350 3 Campers: $525 4 or More Campers: $700
Camper Fee with Teacher Discount

1 Camper: $87.50 2 Campers: $175 3 Campers: $262.50 4 or More Campers: $350
Hanoi Program Fee

1 Camper: $100 2 Campers: $200 3 Campers: $300 4 or More Campers: $400
Hanoi Program Fee with Teacher Discount

1 Camper: $50 2 Campers: $100 3 Campers: $150 4 or More Campers: $200
High School Student Program

1 Student: $100 2 Students: $200 3 Students: $300 4 or More Students: $400
High School Student with Teacher Discount

1 Student: $50 2 Students: $100 3 Students: $150 4 or More Students: $200
I am including a $75 late fee after June 5. Important: Registrations received after June 5 may result in your child(ren) not receiving a camp t-shirt. We apologize for this inconvenience. I am applying for a scholarship
Total Participant Fees (Please note, this total does not reflect scholarships.)
Nursery (infant to 3 years old)

This year, we will only be offering nursery for children whose parents are volunteering. There will not be a charge for children whose parents volunteer, but we do ask that you register your child below so we can be prepared to welcome them!
Thursday Morning Nursery

1 Child 2 Children 3 Children
Thursday Afternoon Nursery

1 Child 2 Children 3 Children
Friday Morning Nursery

1 Child 2 Children 3 Children
Friday Afternoon Nursery

1 Child 2 Children 3 Children
Saturday Morning Nursery

1 Child 2 Children 3 Children
Nursery Child 1

First Name Last Name
Birthday

Month Day Year
Date
Nursery Child 2

First Name Last Name
Birthday

Month Day Year
Date
Nursery Child 3

First Name Last Name
Birthday

Month Day Year
Date
Do any nursery participants have allergies, medical needs, or special care information that would be helpful for caregivers to know?
Parent Package
We are offering a parent package that includes entry to all of the workshops, lunch discussion panels, access to lunch at camp, camp t-shirt, and Saturday lunch. This package will provide each family with a nametag at the beginning of the camp that will allow you access to all parent activities while at camp. We are selling the parent package for $75, which this year is a $100 value.
Thursday, June 23rd Parent Orientation- FREE

Immediately following drop-off

Thursday, June 23rd Vietnamese Cooking Class

1:00 – 2:50PM

Parent Package Only

Friday, June 24th Indian Cooking Class

10:00 – 11:50AM

Parent Package Only

Friday, June 24th Adoption Class

1:00 – 2:50PM

Cost at the Door: $15/person

Saturday, June 25th Adult Adoptee Panel

10:00 – 11:50AM

Cost at the Door: $15/person
Parent Package Fee

One Adult: $75 Two Adults: $150 Three Adults: $225
Parent Package Participant 1

First Name Last Name
T-shirt Size
Parent Package Participant 2

First Name Last Name
T-shirt Size
Parent Package Participant 3

First Name Last Name
T-shirt Size
Do any parent package participants have dietary needs or allergies that would be helpful for us to know?
Vietnamese Lunch

We will be having a traditional Vietnamese lunch that parents are welcome to join us for on Saturday. The cost is $10 per adult. This lunch will be provided to the campers, teen counselors, teachers, volunteers, and parent package participants, so please ONLY sign up here if you do not fall into one of those categories.
Adults Coming for Saturday Lunch

1 Adult: $10 2 Adults: $20 3 Adults: $30 4 Adults: $40
Camp T-shirt Order

Camp t-shirts are $20 per shirt this year. It is included in the camper's, Jr. high program, and parent package fee. T-shirts are also free for high school teen counselors and teachers, so please DO NOT include those shirts here.
Youth Small Amount
Youth Medium Amount
Youth Large Amount
Adult Small Amount
Adult Medium Amount
Adult Large Amount
Adult X-Large Amount
Adult 2X-Large Amount
Adult 3X-Large Amount
T-Shirt Total
Total Cost

Below you will find the total of your fees, parent package, Vietnamese lunch, and t-shirts. Please note, the amount calculated below does not reflect scholarships.
Total
Enroll before March 30th and receive the $30 early bird registration discount!
Help Dillon help others

You can make a tax-deductible gift for camp or as an unrestricted gift for Dillon International.
I would like to make a Lifetime Support Services Scholarship Fund donation to help another family have the opportunity to participate in Lifetime Support Services activities:
I would like to make a general camp donation to Dillon in the amount of:
Make a payment

Total for fees, parent package, nursery, t-shirt, Saturday lunch and donations. Visa, Discover and MasterCard only, please.

Make a Secure Payment

USD Vietnam Camp

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Please double check your payment before hitting the Submit button. Did you pay with Visa, Discover or MasterCard only? Our system does not accept other cards. Please double check the card number, expiration date and 3 digits on the back. Please make sure that the address you provided is the address associated with the card.
Thank you!

We are so glad that your child will be joining us!
Should be Empty:

Camper (4 years old by August 1st - 6th grade completed)

Jr. High Students (completed 7th & 8th grade)

High School Students (completed 9th through 12th grade)

Special Considerations and Parental Consent

Adult Volunteers

Participant Fees

Nursery (infant to 3 years old)

Parent Package

Vietnamese Lunch

Camp T-shirt Order

Total Cost

Help Dillon help others

Make a payment