SIMC Elementary Camp Registration March 2026

SIMC Camps Registration 2026
Southwest Indian Ministries
14202 N 73rd Ave., Peoria, AZ 85381
Age 9 to 12 Camp
March 6-8, 2026
*Please read the entire form carefully. Thank you!
Camper's Name*
Male (M) or Female (F)*
Have you attended camp before?
Current Age*
Date of Birth*

MonthDayYear
Date
Grade Level in 2025-26*
Text #*
Email
example@example.com
Mailing Address*
City, State, Zip*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian's Name(s)*
Name of church you attend
Pastor's Name
Name of friend you're coming with or bringing
* Names of all people who have permission to pick your child up from camp:*
Check one:

I will be dropping off and picking up my child at the Christian Community Center (formerly known as the Southwest Indian Ministries Center) 14202 N 73rd Ave., Peoria, AZ 85381I will be dropping off and picking up my child at Camp Pinerock (1400 Pine Dr., Prescott, AZ 86303)

Medical
Insurance
Medical Insurance Company*
(Policy number)*
ALLERGIES: Does your child have any known allergies?*

YesNo
FOODS: What foods is your child allergic to and what happens if he or she eats them?
MEDICATIONS: Please list any medications your child is allergic to:
SEASONAL ALLERGIES:
BEE STINGS OR OTHER INSECT BITES:
PLEASE LIST ANY MEDICAL CONDITIONS OR RECENT ILLNESSES THAT WE NEED TO BE AWARE OF:
MEDICATIONS: ALL MEDICATIONS MUST BE TURNED IN DURING REGISTRATION. Prescription Medications must be in the original container from the Pharmacy with the Dr.'s name and directions clearly visible on the label. Please list the Prescription and Over The Counter Medications your child has with him/her and needs to take during camp along with the instructions for giving them.
Name of Medication / Dosage and Time / Reason for taking
In addition to the medications listed above, I give permission for SIMC staff to give the following medications that I have marked to my child as needed, according to the appropriate age/weight dosing:

Cough Drops or Cough Syrup (Guaifenesin)Ibuprofen (for pain or fever)Maalox for upset stomachTylenol (for pain or fever)Bacitracin or other antibiotic ointment for wound care/infection preventionCalamine Lotion for itch
Make non-refundable $60 check payable to "World Gospel Mission" and mail to SIMC Camps, 14202 N 73rd Ave., Peoria, AZ 85381 before Friday, February 20, 2026.

or after your submission you will be directed to an online form of payment.

Cost & Payment Information
SIMC Camps is a ministry of World Gospel Mission. Camp costs are covered through a combination of donations and camper fees.
The actual cost of a weekend camp is approximately $250 per camper, but thanks to generous supporters, we ask each camper to contribute just $60 to help offset expenses.
We never want finances to prevent a child from attending camp. If your family is unable to pay the full $60, we invite you to give a donation that fits your situation—every bit helps.
If you're able and would like to sponsor another camper, you're welcome to give more than the suggested amount.
Thank you for your understanding and support! To make a payment, visit www.SIMcamps.com/camp and click the Pay Online button under your camp. or you can send a check payable to WGM to SIMC Camp, 14202 N 73rd Ave., Peoria, AZ 85381
Camper Expectations
At SIMC Camp, all campers are expected to participate fully in worship, discussions, and activities so we can learn, grow, and have fun together.
Campers should treat everyone with respect, follow instructions from leaders, stay with their group, and help keep our camp clean and safe. Personal electronics should be put away during organized activities so we can focus on God and each other.
Above all — have fun and participate!
I agree to follow all the camp expectations.
Camper's Signature:*

Clear

Summary:
Parent Summary (Please Read):
We want your child's camp experience to be safe, meaningful, and fun. This agreement explains the activities your child may participate in, gives camp staff permission to provide medical care if needed, allows staff to give medications you approve, and explains how photos or videos may be used for ministry purposes. It also explains that, like any camp experience, there are inherent risks, and that by signing below you agree not to hold the camp or its staff legally responsible for injuries or emergencies that may occur. Please read the full agreement carefully before signing.
Parent/Guardian Participant Agreement
PARENT/GUARDIAN PARTICIPANT AGREEMENT, RELEASE, AND MEDICAL AUTHORIZATION
I, the undersigned Parent or Legal Guardian of the minor participant named below ("Participant"), understand and acknowledge that participation in camp, retreat, travel, recreational, instructional, and adventure activities involves inherent risks, including but not limited to physical injury, illness, emotional distress, property damage, or death.
This agreement is governed by the laws of the State of Arizona.
1. Permission to Participate & Assumption of Risk
I give permission for my child to participate fully in all activities associated with Southwest Indian Ministry Camps (SIMC), World Gospel Mission (WGM), Camp Pinerock, and any affiliated or partner ministries, whether on-site or off-site. Activities may include, but are not limited to, recreation, swimming, instructional programs, transportation, field trips, and adventure activities such as climbing elements, ropes courses, zip lines, archery, paintball, and similar activities.
I understand that these activities involve inherent risks that cannot be eliminated even with reasonable care and supervision. On behalf of myself and my child, I knowingly and voluntarily assume all such risks, whether known or unknown, foreseeable or unforeseeable.
2. Release, Waiver, and Indemnification
To the fullest extent permitted by Arizona law, I hereby release, waive, discharge, and covenant not to sue Southwest Indian Ministry Camps, World Gospel Mission, Camp Pinerock, and their respective owners, officers, directors, employees, volunteers, agents, representatives, and affiliated entities (collectively, the "Released Parties") from any and all claims, demands, causes of action, or liabilities arising out of or related to my child's participation in camp activities, including claims arising from the negligence of the Released Parties.
I further agree to indemnify and hold harmless the Released Parties from any claims, damages, losses, or expenses (including attorney fees) arising from my child's participation or my breach of this agreement.
3. Rules, Conduct, and Early Dismissal
I understand that my child is expected to comply with all camp rules, safety guidelines, behavioral expectations, and staff instructions. I acknowledge that camp leadership reserves the right, at its sole discretion, to limit or terminate my child's participation for reasons including, but not limited to, safety concerns, behavioral issues, or disruption of the program. I understand that early dismissal may occur without refund.
4. Medical Authorization & Emergency Care
I authorize SIMC, WGM, Camp Pinerock, and their designated staff to provide routine first aid to my child. In the event of illness or injury requiring medical attention, and if I cannot be reached, I authorize camp leadership to consent to emergency medical, dental, surgical, or hospital care for my child as deemed necessary by a licensed physician or healthcare provider.

This authorization includes diagnostic testing, anesthesia, and hospitalization when medically advisable.
5. Financial Responsibility for Medical Care
I accept full financial responsibility for any medical care provided to my child that is not covered by insurance, tribal health coverage, or other applicable programs. I agree to reimburse the ministry for any costs incurred on my child's behalf.
6. Medication Administration
I authorize camp staff to administer prescription and over-the-counter medications to my child as provided by me and documented on camp medical forms. I understand that all medications must be turned in during registration, be properly labeled, and be administered according to camp policy and age-appropriate dosing guidelines.
7. Media & Likeness Release
I grant permission for my child's name, image, likeness, voice, or appearance to be used in photographs, video recordings, or other media captured during camp activities for educational, promotional, and ministry purposes by SIMC, World Gospel Mission, Camp Pinerock, and affiliated entities, without compensation or additional consent.
8. Governing Law & Venue
This agreement shall be governed by and interpreted in accordance with the laws of the State of Arizona. Any legal action arising from this agreement shall be brought exclusively in a court of competent jurisdiction within the State of Arizona.
9. Parent/Guardian Certification
I certify that I am the legal parent or guardian of the Participant, that I have read and fully understand this agreement, and that I sign it voluntarily and with full knowledge of its legal significance.
Participant & Parent Information
Emergency Contact Name*
Emergency Contact Phone:*
Parent/Guardian Signature:

Clear
Today's Date:*

MonthDayYear
Date
Should be Empty:

SIMC Camps Registration 2026

Cost & Payment Information

Camper Expectations

Summary:

Parent Summary (Please Read):

Parent/Guardian Participant Agreement

PARENT/GUARDIAN PARTICIPANT AGREEMENT, RELEASE, AND MEDICAL AUTHORIZATION

1. Permission to Participate & Assumption of Risk

2. Release, Waiver, and Indemnification

3. Rules, Conduct, and Early Dismissal

4. Medical Authorization & Emergency Care

5. Financial Responsibility for Medical Care

6. Medication Administration

7. Media & Likeness Release

8. Governing Law & Venue

9. Parent/Guardian Certification

Participant & Parent Information