2022 SNEMN TEEN SUMMER CAMP APPLICATION

2022 SNEMN TEEN SUMMER CAMP APPLICATION
Summer Camp Information:

SENIOR HIGH Camp Dates: June 27-30, 2022

For Students Currently in 9th-12th Grade

Cost: $275 (Cost goes up to $300 on June 1, 2022)

Registration Deadline: June 16, 2022 (or until sellout)

Campground capacity is 250 (leaders and students). We will sell out! We strongly encourage you to register for camp as soon as possible.

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JUNIOR HIGH Camp Dates: July 18-21, 2022

For Students 6th - going into 9th Grade

Cost: $275 (Cost goes up to $300 on June 22, 2022)

Registration Deadline: July 1, 2022 (or until sellout)

Campground capacity is 250 (leaders and students). We will sell out! We strongly encourage you to register for camp as soon as possible.

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Location:

Evangelical Christian Center

574 Ashford Center Road Ashford, CT 06278
Important SNEMN Camp Information

Please take time to read this section.

Questions about Camp? Call the Youth Dept. at: 508-248-3711, Ext. 729

You Must Register through SNE Online Applications. No Walk-ins!
CAMP LOCATION: 574 Ashford Center Road, Ashford, CT 06278

Instructions and General Information!
1. Registrations & payments must be completed through the SNE Summer Camp Online Registrations available at www.snemn.com/summer-camp by the marked deadlines.
2. Camp fees include lodging, meals and recreational activities.
3. We encourage campers to register early to assure them a place at camp. All registrations are filled on a first-come, first-serve basis.
4. Arrival/Check-in time is 1:00-3:00PM.
5. Departure Time is Thursday 12:00PM (Please be prompt).
6. Facilities: All campers will stay in supervised dorms/cabins. Dorms/cabins are not air conditioned.
7. Phones: Camper’s are requested not to call home unless there is an emergency. Permission to use the camp phone must be approved by the Camp Director. Incoming calls are also discouraged unless there is an emergency. In case of an emergency, you may leave a message by calling the camp at 860-429-2743 or the SNE Student Ministries Cell phone at 860-580-6650.
Please Note: Any prescription drugs brought to camp must be in their original bottle. No over-the-counter drugs allowed! These are provided at camp.

General Camp Rules
1. Campers are under the authority of the camp staff during their stay at camp.
2. Campers are not permitted to leave the camp unless a written request by a parent/legal guardian is presented at registration.
3. Campers must stay in their rooms after “Lights Out.” Any camper caught outside after this time without a proper reason will be sent home.
4. Housing will be assigned by gender at birth.
5. Campers are expected to conduct themselves in an appropriate manner at all times and to attend all scheduled activities.
6. Use and possession of tobacco, drugs, alcohol or other illegal contents is strictly forbidden.
7. No profanity, disrespectful or crude conversation is to be used.
8. Keep your room clean. Room checks will be done during morning Chapel services.
9. Respect other camper’s belongings.
10. Do not damage or deface any camp property. If something is broken, report it immediately. Unnecessary damage will be charge to the person(s) responsible. If the guilty person(s) cannot be found, the cost of the repair will be shared by each camper in the room.
11. Check Out at the end of the week at the registration table. Each camper will be free to go home AFTER their room has been cleaned and approved by the Camp Director.
Campers should understand that violations of camp rules may result in disciplinary action, the contact of their parent/legal guardian with the possibility of being sent home and forfeiting their camp fee.

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What To Bring:
- Modest Attire - T-shirts and shorts are acceptable. No tank tops or midriffs permitted. Shorts must be “finger tip” length from the knee. If you are not appropriately dressed, you will be sent back to your room to change.
- Extra Clothing.
- Clothes that can get dirty. Some games can get messy.
- One-Piece Swimsuits Only
- Sleeping Bag or sheets, blankets and pillow
- Towels
- Flashlight
- Bible & Notebook
- Personal Care Items: Soap, shampoo, toothpaste, etc.
- Spending Money
- Rain Gear
- Sneakers
- Bug Spray
What NOT To Bring:
- Electronic Games
- Firearms / Fireworks
- Tobacco
- Cell Phones
- Illegal Drugs
- Knives or Weapons
- Over-the-Counter Drugs
- Pornography
- Expensive Jewelry
- Revealing Clothes
WHICH CAMP IS YOUR STUDENT ATTENDING? *

Senior High: June 27-30, 2022 (Currently in 9th - 12th Grade) Junior High: July 18-21, 2022 (Currently in 6th - 8th Grade)
Select your church below. If you do not see your church listed you can add it by selecting "Add Option" from the bottom of the dropdown menu.
Church Name: *
Camp Coordinator's Name *
Camp Coordinator's Name. Example: Your Youth Pastor
Camp Coordinator's Phone *
Please enter a valid phone number.
Camp Coordinator's/Youth Pastor's Email: *
example@example.com
Person/church picking up from Evangelical Christian Center: *
Who is picking you or your group up from camp?
General Information

2021 SNEMN Teen Camp
Camper Name: *

First Name Last Name
Camper Address: *

Street Address

Street Address Line 2

City State

Zip Code
Date of Birth: *

Month Day Year
Date
Gender at Birth: *
Housing will be assigned by gender at birth.
Age: *
Current School Grade: *
Mother/Guardian's Name: *

First Name Last Name
Mother/Guardian's Phone: *
Please enter a valid phone number.
Father/Guardian's Name: *

First Name Last Name
Father/Guardian's Phone: *
Please enter a valid phone number.
T-Shirt Size *
Shirts are available on a first come, first served basis.
Confirmation Email: *
example@example.com
Emergency Contact (If different than parent): *
First and Last Name
Emergency Contact Phone: *
Please enter a valid phone number.
Desired Roommate:
Activity Participation

Activities, including but not limited to:

Swimming (pool and lake), Hiking/Outdoor Activities (In which participants could possibly get bites from insects, ticks, mosquitos, spiders, and/or snakes, etc...), Jumping, Throwing, Field Games, Canoeing (life jackets required for all participants), Water Inflatables, Outdoor Sports, Indoor Game Room, Walking/Running, Food Challenges, Recreational games (relay race styles, tug-of-war, etc., which may involve water and mud). Extra Activities include: Tubing, Paintball.
Does your child have the ability to swim? *

Yes No
If Yes, are you allowing your child to swim at camp? *

Yes No
Does your child have permission to participate in camp activities? (If no, please provide a separate sheet listing which activities you do not want them to participate in.) *

Yes No
Date and Location of Activities:

Evangelical Christan Center, 574 Ashford Center Rd, Ashford, CT 06278

(1) Sr. High Camp: June 27-30, 2022

(2) Jr. High Camp: July 18-21, 2022

(3) Kid’s Camp: August 8-11, 2022
Medical Information

Please Note: At the completion of this application you will receive a physicians form emailed you that needs to be completed by your physician OR a similar form provided from your physician’s office that includes: (1) Physical Examination Date (within two years of camp date), (2) Up to date Immunization Record and (3) Signature by physician.
Family Doctor: *
Physician's Phone: *
Please enter a valid phone number.
Insurance Company: *
Policy/Group #: *
Is your Child presently being treated for injury/sickness or taking any form of medication? If yes, explain. *
Are there any special medical instructions? *
Any medication, foods or environmental conditions that Child is allergic to, and expected reactions? *
Any physical handicaps, disorders and diseases? *
Are there any mobility limitations or activities you would not like your Child to participate in? No Yes (explain) *
List all medications to be administered at Camp: *
History of: *

Seizures Heart Trouble Diabetes Sore Throat Kidney Bowel Problems Bleeding Fainting Menstrual Problems Sleepwalking Bedwetting Nosebleeds Headaches Allergies Hay Fever Asthma Reachtion to Bee Stings Reaction to Plants None Other
IMPORTANT COVID-19 NOTE: WE WILL BE FOLLOWING THE STATE OF CONNECTICUT'S COVID-19 GUIDELINES THAT WILL BE IN PLACE DURING THE TIME OF CAMP.
All medications must be in original container and clearly labeled: patient’s name, physician’s name, name of medication, prescription number, date prescribed, instructions. DO NOT SEND OVER-THE-COUNTER Medications (i.e.Tylenol or Advil) as the nurse has these on hand. Exception: Claritin with Doctor’s note and instructions. The following over the counter medications will be available in brand name or generic name and age appropriate dosing and form, i.e. liquid or tablets and will be given according to label dosing guidelines: Acetominophen (Tylenol), Ibuprophen (Advil), Benadryl, Sudafed, Mylanta, Tums, Immodium, Auri-Dri, Neosporin, Calamine Lotion, Hydrocortisone Cream, Robitussin, Cough Drops, and any other over the counter medication deemed necessary. If your child takes another OTC medication on a regular basis, please send that with a doctor’s note for administration at camp.
Southern New England Ministry Network

Authorization Release/Disciplinary Clause

I understand that participation in camp activities with the Southern New England Ministry Network Camp brings with it a certain amount of risk. I acknowledge and accept the risks of physical injury associated with participation in the activities (including extra activities of paintball and tubing) described in the camp registration. Should there be any activity for which I wish for my child to abstain from, I will notify the Southern New England Ministry Network Camp in writing at the time of registration. In consideration of the risks involved, I understand that the Southern New England Ministry Network Camp and Evangelical Christian Center have taken the necessary precautions to ensure the safety and well being of my child. I hereby release and waive any and all claims against the Southern New England Ministry Network Camp, Evangelical Christian Center, and its staffs arising from his/her participation in the Southern New England Ministry Network Camp. I also release and waive all personal financial responsibility for any injury or loss sustained during the activities and hold both the Southern New England Ministry Network (and its representatives), and Evangelical Christian Center harmless for such injury or loss arising directly or indirectly from said activities.

The health history included in this application is correct as far as I know and the person herein described has permission to engage in all prescribed activities, except as noted by the physician and me. IN CASE OF EMERGENCY, I hereby give permission to the physician to secure proper treatment, including hospitalization, anesthesia, surgery, or injections of medication for my child. I hereby give my consent, in the event that all reasonable attempts to contact me have been unsuccessful, for the administration of any treatment deemed necessary by the appropriate licensed physician, nurse, dentist or emergency personnel. I also give permission for the Camp Nurse to administer over the counter medication to my child as deemed necessary according to dosing guidelines and attend to any other necessary healthcare means.

I also hereby understand that if my child refuses to adhere to the camp rules and policies listed herein, I may be called to bring him/her home immediately. I also hereby give permission to the camp team leader and/or other member of the camp staff to inspect the contents of any or all of my child’s personal belongings, and to withhold and/or dispose of any improper or illegal contents. I also hereby give permission for my child to be transported off grounds to participate in the recreation activities of the camp program.

If a dispute over this agreement or any claim for damages arises, the participant (or parent/legal guardian) agrees to resolve the matter through a mutually acceptable arbitration process.
IMPORTANT COVID-19 NOTE: WE WILL BE FOLLOWING THE STATE OF CONNECTICUT'S COVID-19 GUIDELINES THAT WILL BE IN PLACE DURING THE TIME OF CAMP.
Parent/Legal Guardian Name: *

First Name Last Name
Parent/Legal Guardian Signature: *

Clear
Date: *

Month Day Year
Date
Witness Name: *

First Name Last Name
Witness Signature: *

Clear
Date: *

Month Day Year
Date
Student Consent:

I will abide by all camp rules (listed above). I understand violation of these guidelines may result in my immediate dismissal from camp at parent/guardian’s expense.
Camper Signature: *

Clear
Please Enter Name: *
Southern New England Ministry Network Photo & Video Release Form

I hereby grant the Southern New England Ministry Network permission to the rights of my image, likeness and sound of my voice as recorded on audio or video without payment or any other consideration. I understand that my image may be edited, copied, exhibited, published or distributed and waive the right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of my image or recording.

I agree that the Southern New England Ministry Network may use such images, video and/or audio of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and web content.
There is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be distributed.
By signing this form, I acknowledge that I have completely read and fully understand the above release and agree to bound thereby. I hereby release, defend, hold harmless and indemnify the Southern New England Ministry Network from any and all claims for utilizing this material.
Child's Full Name: *

First Name Last Name
Child's Address *

Street Address

Street Address Line 2

City State

Zip Code
Phone Number *
Please enter a valid phone number.
Email
example@example.com
Child's Signature *

Clear
If this release is obtained for someone under the age of 18, then the signature of that person’s parent or legal guardian is also required.

I verify that I am the parent/guardian of the minor named above and have the legal authority to execute the above release. I have read this release and fully understand its contents. I approve the foregoing and waive any rights in the premises.
Date Signed

Month Day Year
Date
Parent/Legal Guardian Signature:

Clear
Southern New England Ministry Network

PHYSICIAN’S HEALTH FORM

This form needs to be completed by your physician OR a similar form provided from your physician’s office that includes: (1) Physical Examination Date (within two years of camp date), (2) Up to date Immunization Record and (3) Signature by physician.

All campers must have a physical within TWO years of the start of camp. Copies from last year are not available.

Send this medical form to your doctor NOW! DO NOT WAIT! Be sure this form is filled out COMPLETELY and send it back to your church’s camp coordinator by the registration deadline date. This form is REQUIRED to be sent in with the camp application and is REQUIRED for your child to stay at camp. Do not leave any lines blank. This helps our medical staff care for your child.

The following link contains the Physician's Health Form that is REQUIRED for registration completion.

Please click the link to download the PDF and have your Physician's office complete the document. CLICK HERE TO DOWNLOAD THE SNEMN CAMP PHYSICIAN'S FORM

After the form is completed, please send the office or upload it using the File Upload option below.

Forms can be mailed to:

The Southern New England Ministry Network

307 Sturbridge Road

Chartlton, MA 01507
Upload Completed Medical Forms Here

Cancel of
REGISTRATION COSTS

Choose Your Registration. Please note that if you have additional children you will have to fill out a separate registration application for each child.

Do you have more than one child attending SNEMN summer camp?

Sibling discounts are availble upon request until June 1st.

Please email Chris Hurtado at chris@snemn.com for your sibling coupon.

Registration: *

SC - Summer Camp - Registration Prices goes up to $300 on June 1st. (T-shirts are not guaranteed and are only given out as available).

$ 275.00

Enter coupon

Total

$ 0.00

Credit Card

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2022 SNEMN TEEN SUMMER CAMP APPLICATION

Summer Camp Information:

Important SNEMN Camp Information

Questions about Camp? Call the Youth Dept. at: 508-248-3711, Ext. 729

You Must Register through SNE Online Applications. No Walk-ins! CAMP LOCATION: 574 Ashford Center Road, Ashford, CT 06278

Instructions and General Information!

General Camp Rules

What To Bring:

What NOT To Bring:

General Information

Medical Information

Southern New England Ministry Network

Authorization Release/Disciplinary Clause

Southern New England Ministry Network Photo & Video Release Form

Credit Card

You Must Register through SNE Online Applications. No Walk-ins!
CAMP LOCATION: 574 Ashford Center Road, Ashford, CT 06278