Middle School Camp Application 2025

Student Information
Name*

First NameLast Name
Gender*
Date of Birth*

MonthDayYear
Date
Grade*
Exiting 6th grade - those exiting 8th grade
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Nazarene Church Information*

Church NamePastor's Name
Camp Rules & Information

Please read through the rules carefully and at the end sign that you agree to the terms & conditions
CAMP RULES

The camp is owned and operated by the West Virginia North and South Districts Church of the Nazarene, for the Glory of God, the proclamation of the gospel of Jesus Christ, emphasizing Holiness, Evangelism, the preservation of the faith delivered to the saints the growth and strengthening of the Church of the Nazarene, especially it’s ministry to youth.
1. No smoking or using tobacco products in any form, (including e-cigs, vapes, etc.), drinking of intoxicating beverages, unauthorized use of drugs in any form on camp property. (Any medications must be registered with the Camp Nurse.)
2. There is to be no sexual conduct on the campgrounds.
3. All campers are expected to conduct themselves in a Christ Like manner.
4. Cell Phones, Video Games, etc. will be confiscated if abused, no phones are permitted in our around the bathhouses.
5. All campers assigned a room must use that room.
6. Under no circumstances, will males be permitted in the ladies dorm area, nor females allowed in the men’s dorm area.
7. No explosive materials, fireworks, firecrackers, etc. are permitted on the campground.
8. Any damage to property will be charged to the offender.
9. Attendance is required at all classes, services, and sporting activities.
10. Public display of affection will be limited to holding hands.
11. We have a zero tolerance for bullying, racial or sexual harassment, or any form of descrimination.
12. Dress - Modesty is our rule:a. Both male & female are to dress modestly & appropriately at all times while on camp property.
  1. Both male & female are to dress modestly & appropriately at all times while on camp property.
  2. T-shirts are to be worn over swimsuits during swimming, lake and river activities
  3. All campers are to wear shirts at all times outside of the dorms.
  4. Shoes are to be worn at all times.
  5. Sun dresses, halter tops, tank tops, and muscle shirts are unacceptable unless you wear a jacket or shirt over them.
If discipline merits a camper being sent home, the camper will be suspended one year from all campground activities including Singspiration, Family Camp, Assemblies and their age appropriate camp the following year. Camper is permitted to participate in Family Camp only with direct supervision of a parent or guardian.

If disciplinary action is taken to merit sending a camper home, the Camp Director will notify in writing; Parents/Guardians, Pastor, District Superintendents, and appropriate Camp Director for the next year.

Signatures below indicate rules have been read, understood and agreed to:
Camper Signature: *

Powered by Jotform SignClear

Parent(s)/Guardian(s) / Emergency Contact Information
Please list in order of whom to contact first*
Name

First NameLast Name
Relationship
Phone Number
Are there any custody arrangements or conditions the camp director should know about?*

YesNo
If yes, please specify:
Health Information
Family Doctor*

First NameLast Name
Doctor's Information*

NamePhone Number
Insurance Information*

Policy ProviderPolicy Number
Insurance Card Picture If Possible

Cancelof
Please let us know if this child have any allergies*
List medications if this child is currently taking*
Specify Times & Medication Information as needed
Have this child had any serious illnesses or operations?

YesNo
If yes, please describe
Can this child take part in regular physical activities?*

YesNo
Do you want to indicate any related information?
Nazarene Camp Information
Personnel: Counselors and staff members are carefully chosen, consecrated Christians, including pastors and laymen. Every Nazarene pastor is encouraged to participate in camp by working in some capacity unless providentially hindered.

Health: A nurse will be on duty at all times. Supplemental insurance is provided for each camper. Applicant’s primary insurance company is to be used under medical information.

Recreation: Activities, sports, and recreation will be age group appropriate for each camp.

Lodging: All campers are required to be lodged in the assigned dorm rooms.

Dress: Modesty is our rule. Campers are to be neat and clean for all worship services and evening meals. Campers displaying extreme variation from modesty will be asked to change. The camp director of each camp will have discretion over the appropriateness of dress. Shirts and shoes must be worn at all times outside thedorms. Prohibited clothing items include muscle shirts, tank tops, offensive logos or sayings, Crop top shirts, see through or similar material.

We do have dress up days with themes. Check out socials for those lists!

Food: Well balanced meals will be prepared by qualified dietitians.

What to Bring:
- Sleeping bags or sheets and blanket, pillow, towels, wash cloths, personal grooming aids,clothes, recreational clothing, bathing suits, swim shoes (or old tennis shoes), pajamas, robe, umbrella or raincoat, camera, Snack Bar money, and great expectations.
- Closed-toed shoes REQUIRED for Ace Adventure White Water Rafting
Technology: Please refrain from bringing game systems.
- Phones or personal media devices will be confiscated if abused.
- Phones are not permitted in the shower/bathroom areas. Picture taking is not permitted within the dorm rooms.
- Phones are not permitted during Chapel service. Students are not permitted to contact parents to go home without first talking with the directors.
Special Needs: Please provide information concerning any special conditions /needs the camper may have. All special needs issues will be kept confidential.

Arrival Time: All campers should be on the campgrounds by Noon Monday. Lunch will be the first meal served.

Departure Time: All campers should be picked up by Noon on Friday.

WEST VIRGINIA NAZARENE CAMP POLICY REGARDING GENDER IDENTITY AND HOMOSEXUALITY IN THE CONTEXT OF EXTENDED/OVERNIGHT STAYS:

Our statements of faith and proper Christian practice are outlined by our parent denomination in the Church of the Nazarene Manual (current version). We agree with all statements and the expectations laid out in that document. As the governing board for West Virginia Nazarene Camp, we agree with the Manual statement on Human Sexuality and abide by the practices of a Biblical world view. We interpret and apply the principles presented in the Church of the Nazarene Manual to extend to the following scenarios:

GENDER IDENTITY:

We believe that God fearfully and wonderfully creates each of us either male or female. This is not a decision for us to make, but one God, Himself has already made. Identifying as a gender other than that which one was born is not recognized as a practice in keeping with the Scripture.

Furthermore, the Manual of the Church of the Nazarene outlines our understanding of Christian sexuality and marriage. (Paragraph 31) We believe that gender identity conflicts are a derivative of the perversion of human sexuality. Those dealing with gender identity issues are to be loved and cared for as Christ would love and care for any of us dealing with confusion and sin. However, we do not affirm an individual choosing to identify as a gender other than their gender at
birth.

HOMOSEXUALITY AND GENDER IDENTITY IN THE CONTEXT OF EXTENDED/OVERNIGHT STAYS

In keeping with the statements regarding homosexuality in the Church of the Nazarene Manual and those statements as they pertain to gender identity issues, we have concluded the following regarding individuals who identify as homosexual
or who identify as a gender other than that which one was born - who wish to attend an overnight retreat, camp, etc. where individuals of the same gender sleep, bathe, and disrobe in close proximity and/or open view of one another. Our goal is never to shame someone who is dealing with one particular sin, but instead, to assist them in every possible way to embrace an eternally transformative relationship with Christ who conquers sin in our lives. With this being our focus, it is our policy that:

1) An individual who would classify himself/herself as one of the above described who is not yet 18 years of age who is seeking to attend an extended overnight event with a group at West Virginia Nazarene Camp or any of its ministries, programs, or sponsored activities, must be accompanied by a parent or guardian and must obtain private lodging onsite or elsewhere with said parent or guardian where sleeping, bathing, and disrobing can be done separate from the group under the sole supervision of the parent or guardian. Extra costs incurred by obtaining this private lodging are the sole responsibility of the individuals obtaining lodging. To maintain the safety of minors attending the event, the chaperoning parent or guardian must submit to and pass a criminal background check through the camp &/or West Virginia North or South District Offices.

2) An adult individual who would consider himself/herself as one of the above described who is seeking to attend an extended/overnight event with a group West Virginia Nazarene Camp or any of its ministries, programs, or sponsored
activities, must obtain private lodging onsite or elsewhere where sleeping, bathing, and disrobing can be done separate from the group. Extra costs incurred by obtaining this private lodging are the sole responsibility of the individuals obtaining lodging.
Parent / Guardian Waiver of Claim

I hereby approve of the application to Nazarene camp and certify to the correctness of the information provided and expressly waive any and all claims against the West Virginia North District or West Virginia South District Church of the Nazarene, or any of the District Boards or its representatives because of injury or other damages that may be incurred to named applicant or said applicants in connection with our incident to the Church of the Nazarene Summer Camp program at Summersville, WV.I have read all the information on this application, including the rules and what my child is to bring to camp. I give my permission for the applicant to attend camp. I will come, upon request of the director in case of disciplinary action to take the applicant home. I permit to the West Virginia North District / West Virginia South District Camp to use any pictures or videos taken during camps to be used for promotional materials, published articles, or Nazarene websites.
Parent/ Guardian Signature*

Powered by Jotform SignClear

ACE Adventure

Please follow the directions and upload the document you receive in your email. Your child cannot attend ACE without a waiver.
Please choose ONE event your child will participate*

White Water Rafting (additional $70)ACE Waterpark
To begin: Go to following link https://aceraft.com/online-waive

Next, follow the steps below!

Payment Information

You can pay via check, cash or online by credit card. Check or Cash Payment should be mailed. Make sure to include who the payment is for when mailing! See prices below.

Mail to:

Laura Crouch

1605 West Dupont Avenue

Belle, WV 25015

All credit card payments will have a 2% charge rounded to nearest dollar.
Credit Card Payments:
prevnext( X )
Early Registration with:ACE Adventure Water Park
$184.00 Quantity



Early Registration with:ACE White Water Rafting $70 more
$255.00 Quantity



Mailing Cash or Check
$ Free Quantity



Total

$0.00
Should be Empty:

Student Information

Camp Rules & Information

Parent(s)/Guardian(s) / Emergency Contact Information

Health Information

Nazarene Camp Information

Parent / Guardian Waiver of Claim

ACE Adventure