Camp Connect Epworth by the Sea

Camp Connect Epworth by the Sea

Please fill out the form below to register your child for Camp Connect. There is a $50 NON-REFUNDABLE deposit due at registration. You have until the day of camp to pay the remainder of your camp tuition. Please make any checks out to Gray United Methodist church and write "Camp Connect" in the memo. If you have any questions, please email Kristin at coffeebean848@gmail.com. Camp Dates are as follows: High School Camp (rising 9th -12th grade)- June 12th-16th, Middle School (Rising 6th-8th graders)- June 26th-June 30th, Elementary (rising 4th-5th grade)- July 17th-21st. Cost of camp is currently $415.
Child's Name*

First Name Last Name
Child's Gender*

MaleFemale
T-Shirt Size*

Youth MediumYouth LargeYouth XLAdult SmallAdult MediumAdult LargeAdult XLAdult XXL
Grade entering Fall of 2023*

4th5th6th7th8th9th10th11th12th
I am registering my child for this camp:*

High School Camp (entering 9th-12th grade): June 12-16 2023Middle School Camp (entering 6th-8th grade): June 26-30, 2023Elementary Camp (entering 4th-5th grade): July 17-21, 2023
Age of Camper (as of first day of camp)*
Birthday MM/DD/YYYY*
Home Address Street address/PO Box*
City*
State*
Zip Code*
Church: the local church that the camper attends, if applicable.
Choice of Cabin Mate- Please choose only 1 cabin mate. Request must be mutual to be guaranteed.
PARENT/GUARDIAN 1 Name*

First Name Last Name
Relationship to Camper*
*Cell Number with Area Code*
Work Number with Area Code
PARENT/GUARDIAN 2 Name*

First Name Last Name
Relationship to Camper*
*Cell Number with Area Code*
Work Number with Area Code*
*Emergency Contact Name (First and Last)Please make this different from Parent/Guardian information. We will always contact Parents/Guardians first in case of emergency.*

First Name Last Name
Relationship to Camper*
Emergency Contact Number with Area Code*
Allergies- Select all that apply:*

No known allergiesFoodMedicineEnvironment (insect stings, hay fever, etc)Other
Please specify below what the camper is allergic to and the reaction seen.
Diet and Nutrition: Select one answer below.*

Regular DietVegetarianLactose intolerantGluten intolerantOther
Please specify below any diet/nutritional information that would affect a normal dining hall (buffet) meal time.
Will the camper take any daily medications while attending camp?*

YesNo
List any medications with dosage/timing and reason for taking it. Original packaging/containers are required with physician's instructions for dosage on the label.
The following non-prescription medications may be stocked at Camp and used on an as-needed basis to manage illness and injury. Please check which one(s) the camper SHOULD NOT be given.

Acetaminophen (Tylenol)Ibuprofen (Advil, Motrin)Antihistamine/Allergy MedicineDiphenhydramine antihistamine/Allergy Medicine (Benadryl)Sore throat sprayGeneric cough dropsLice ShampooAntibiotic CreamAloeNausea medicine (Pepto Bismol, Dramamine)
Choose any condition that applies to camper.*

Recurrent / Chronic IllnessRecent infectious diseaseRecent injuryAsthma / Wheezing / Shortness of breathDiabetesSeizuresHeadaches / MigrainesFainting / DizzinessBedwettingSkin Problems / EczemaGastrointestinal (Diarrhea / Constipation)OtherNo known health problems
Please explain any conditions in the box below.
Date of Last Tetanus Shot- MM/DD/YYYYType a question*
Has the camper ever been treated for attention deficit disorder (ADD) or attention deficit/hyperactivity disorder (AD/HD)?*

YesNo
*Has the camper ever been treated for emotional or behavioral difficulties or an eating disorder?*

YesNo
During the past 12 months, has the camper seen a professional to address mental/emotional health concerns?*

YesNo
Has the camper had a significant life event that continues to affect the camper's life? (History of abuse, death of a loved one, family change, adoption, foster care, disaster survivor, other)*

YesNo
Please explain all "yes" answers in the box below.
Do you Carry Family Medical Insurance?*

YesNo
If you do not have insurance or use a medical sharing plan, explain your coverage of medical expenses below.
HEALTH & WELL-BEING + EMERGENCY CARE

The information given on this registration form is correct and accurately reflects the health status of the camper to whom it pertains. The camper has permission to participate in all camp activities except as noted by me. I understand that in special situations, a medical doctor's statement may be needed. I give permission to the physician selected by the camp to order x-rays, routine tests, and treatment related to the health of my child for both routine health care and in emergency situations. I understand the information on this form will be shared on a "need to know" basis with camp staff.

An inherent risk of exposure to communicable diseases, including but not limited to, COVID-19 exists in any public place where people are present. BY VISITING CAMP CONNECT LOCATED AT EPWORTH BY THE SEA, ST. SIMONS ISLAND, I VOLUNTARILY ASSUME ALL RISKS RELATED TO EXPOSURE TO COMMUNICABLE DISEASES FOR MY CHILD.

I will not send my child with a fever of 100 degrees or more or any chronic health conditions that would put him/her at an increased risk of significant illness. In allowing my child to take part in this program, I have also considered other household members and those with whom my child has frequent contact with who are elderly or at increased risk of severe illness from communicable diseases.
Permission to Seek Emergency Medical CareEnter your name below. By typing your name and signing in the area below you are verifying your name and date of this signature.*
HONOR CODE

It is our goal to offer every camper a unique experience where they not only learn, grow and have fun, but also feel safe physically and emotionally. In order to do this, we ask that each camper abide by certain guidelines.

Behavior Policy: The ability to effectively interact in a small group and within a community-living environment is important to the Camp Connect experience. Cabins have 8-10 campers, while Teams include 15-20 campers and two college-aged counselors. Campers will be expected to effectively interact with others to accomplish community-building goals. On the first day of camp, each Counselor will go over camp policies and rules. If the camper has any questions, they are free to ask in order to clarify expectations of daily camp life. We do not tolerate fighting, bullying, vulgar language, disobedience, camper disruption or the possession of all forms of nicotine, alcohol, illegal drugs or weapons. If any camper is found acting in such behavior, or in the possession of items mentioned, they will be sent home early from camp.

Procedures for Disruptive Behavior:

1. We will first talk with the camper and let them know that the behavior is unacceptable and talk through the desired behavior. We will also attempt to let the camper know that he/she is cared for, but certain behaviors are not tolerated at camp.

2. If the behavior continues, Camp Connect Staff will contact the parent/guardian(s) to make them aware of the situation.

3. If the behavior persists, the Camp Director has the right to determine if the camper should remain at camp or be sent home. Because we are limited on time with the campers and also depending of the severity of the behavior, some actions may result in immediate dismissal.

Health: All medication (both prescription and over the counter) must be turned in at registration in its original container, including the Physician’s instructions for dosage on the label.

Visitors: Being away from your child can be difficult on both the parent/guardian(s), as well as the campers; however, visiting can cause many disruptions in acclimating into the camp environment. At Camp Connect, campers experience the camaraderie of other campers and are led to acquire skills that improve self-confidence, increase self-reliance and enhance the ability to cooperate with others. Because of this, we do not allow any outside visitors during the camp session.

Cell Phones: We know that in today's culture many of our campers and parents stay in daily communication via cell phones. We also understand the trust that you are placing in us by allowing your camper to come to camp without a cell phone. We believe that there is a very real value in your camper spending a week unplugged and disconnected from digital life. We believe that taking time off from our phones, computers, social media, and video games can open up the space in our minds and hearts to hear and feel God at work. If there are any situations regarding your camper while at camp that you need to be made aware of (medical issues, severe homesickness, etc.) we will contact you.

Bunkmates: ONE bunkmate request is guaranteed only if the request is mutual. Groups of 3 or more are not guaranteed as we promote new friendships among campers.

I have read and agree to the above Policies and Procedures for Camp Connect. I have discussed the noted expectations with my camper. I also understand that there will be no refund for any camper sent home early.

As a good steward of what God has entrusted to me and to preserve my witness, I agree to protect, care for, and be responsible for the property of the place at which I stay/meet. I also agree to abide by any and all rules placed on me by these entities. Administration reserves the right to send any person or group home who jeopardizes the purpose of the event for others by their misconduct. As a representative of Christ and His Church, we take seriously our responsibility to one another and our concern for the well-being of the total community.
I agree to the policy and procedures outlined in this honor code.*
Enter your name below. By typing your name and signing in the area below you are verifying your name and date of this signature.
Photos will be taken during camp that may be used for future camp promotions and our social media pages. Please enter Parent/Guardian initials.*
I understand and agree that I will have to pay a NONREFUNDABLE deposit of $50 in order for my child to be registered at Camp Connect. Registration is first come, first serve and is subject to change due to availability. Please drop off a check or cash in a labeled envelope to either Beth Thomas or Jessica Connell at the church office.*

YesNo
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