Summer Camp 2026 Camper Registration and Health Forms

  • Summer Camp 2026 Camper Registration and Health Forms - Important Instructions 
     

    PLEASE READ THROUGH THE INSTRUCTIONS COMPLETELY - DO NOT SKIP!!

     

    Please complete the google form to complete registration for your child for People of God Summer Camp 2026. The health form and waivers are also included in this online form and must be completed. Please be sure to have all the needed medication names, medical history, insurance information, credit card, etc. on hand before beginning the form if possible. Payment is due before form can be submitted!

    Due to the conditional formating of this form! It will work best if completed from top to bottom (the first question to the second question and so forth - except when clicking save). Please do not jump around the document. Answer the questions one at a time and in order, and you will save yourself many headaches. You can always come back and reread this instruction page. 

    *** After completing the basic contact info and after you answer the "email address" question please take a moment scroll to the bottom of the form and click "Save" this will allow you to pick up where you left off, should you be unable to finish the form. If you do not hit SAVE periodically, your progress will be lost. After hitting save you will be prompted with a Jotform popup (it may look like the image below if you have not filled out a jotform before). You do not need a jotform account to save the document simply choose the option that sends a link to your email for easy access to the form. This is in small blue print and says "Skip Create an Account". You can then enter the email that you want Jotform to send the access link to. Make sure to check your junk mail if you do not see it immediately. Upon the completion of more questions, make sure to hit "Save" once more before exiting the form. And do not forget to hit "Submit" at the very end of the form.

     

     

      

    Proceed through the registration until you see the screen below. Your responses have not been submitted until you see the following screen!!!

     

     

     

    If you have any questions, please email pogcamp@gmail.com.

    Joel Pepmeyer, Seth Porterfield, and Beth Mayer

  • Registration Information

    Head and assistant cabin counselors will be provided a copy of this pages responses so as to help best serve your camper throughout the week. If you have questions, please save your progress and email pogcamp@gmail.com
  • Camper Birth Date*
     - -
  • Present Grade in School (grade they were/are most recently in at the time of the completion of this form)?*
  • Sex*
  •  -
  • Community Affiliation (if applicable)*
  • Can your child sleep on the top bunk?*
  • Is it likely that your child will wet the bed?*
  • I understand the cost of camp is $430 per camper (for 6th graders: $30 additional for adventure trip)*

  • Camper Health Form Information

    This health information will go directly to our nursing staff.
  • Format: (000) 000-0000.
  • If female: has she been told about menstruation?
  • Has she menstruated?
  • Has/does the Camper have: (check all that apply)*
  • We would like to do our best to support your child's mental health while at summer camp. Please check any that apply below being as specific as you can. (*If your child takes a break from their medications during the summer, we do suggest you consider resuming them for the week of summer camp, due to the rigorous schedule of summer camp.)*

  • Consider Scrolling Down and Clicking "Save" at this point - your progress will be saved to the link that Jotform previously sent you via email

  • Does your child have any allergies? (medicine, environmental, food, etc.)*

  • Allergy Information

  • Does your child carry an epipen?

  • Additional Allergy Information
  • Has your physician given your child a written allergy action plan? (The Camp Nurses will be requesting a copy)

  • Asthma

  • Does your child have asthma?*
  • Does your child carry a rescue inhaler (for asthma or any other reason)?*

  • Immunization Information

  • Date of last Tetanus shot*
     - -
  • Are you up to date with all the vaccinations required by your local school district?*

  • If there is an outbreak of a communicable disease you will be contacted and made aware of the situation

  • Medications

    Please list all prescription and any over the counter medications your child takes. Don't forget to include inhalers and/or epipen. You must include the following: MEDICATION NAME, DOSE (total # of pills/dose and mg/dose), FREQUENCY, TIMES NORMALLY TAKEN AT HOME, REASON, and IF THE MEDICATION SHOULD BE TAKEN AS NEEDED. Please simply list N/A (for Medication #1) if you do not have medication needs.

  • All prescription medication must be brought to camp in a current and correctly labeled prescription bottle(s) and all over the counter medication must be in its original packaging!!

  • Additional Medications

    If you will be bringing more than six medications to camp, please email this additional information to Sarah Gold, camp nurse. Email address is sjg3232@gmail.com

  • Illness Protocol

  • Consider Scrolling Down and Clicking "Save" at this point - your progress will be saved to the link that Jotform previously sent you via email

  • Insurance Information

    If you do not have traditional health insurance , put NA in the required boxes and explain in the "any other info we should know" box below
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Electronic Signature

    By electronically signing your name below, you are verifying that all information included in this form and heath record is accurate to the best of your knowledge. Any changes in information prior to arrival at Summer Camp will need to be communicated with the directors and/or the nurse via the email address pogcamp@gmail.com . I also understand that all prescription medication must be brought to camp in a current and correctly labeled prescription bottle(s) and all over the counter medication must be in its original packaging.

  • Waivers/Releases

    Below you will find our waivers/releases for camp. It is your job to read them in their entirety, so you know what you are signing. By signing electronically, you are agreeing that your electronic signature will serve as your physical signature, and you agree to be bound by the contents of the following waivers/releases which you have filled out. One signature shall be collected for the whole collection of waivers and releases. The permissions this signature entails will apply to the child this form has been filled out for.

  • WAIVER OF LIABILITY

    I, hereby undersigned, have given permission for my child to attend the People of God Summer Camp from July 12, 2026 through July 18, 2026 at All Saints Ukrainian Orthodox Camp.

     I agree to waive any claims against the People of God and its appointed camp personnel based on any theories of recovery in law and equity. Further, I agree to indemnify and hold harmless the People of God and its authorized agents and representatives from any and all costs and expenses such as attorney’s fees, costs of investigation or discovery, court costs, and other sums in connection with any legal claim or action arising from my child’s use of real or personal property of the People of God and the All Saint’s Campground.

  • Do you consent?*

  • AUTHORIZATION OF CONSENT TO TREATMENT

    I give permission on behalf of my minor child to all authorized agents and representatives of the People of God to give, obtain and consent to both routine and emergency health care.  In case of emergency, I understand every effort will be made to contact me.  In the event I cannot be reached, I hereby give specific consent in advance to the physician or surgeon selected by an adult representative of the People of God to secure any and all proper treatment, including hospitalization, x-ray examination, anesthesia, surgery, or injections of medication for my son or daughter, whether such treatment is administered at the office of said physician or at a hospital.  I give permission to the camp to provide transportation related to any health needs of my child and I agree to the release and/or photocopying of any records for the purposes of treatment, referral, billing or insurance.

  • Do you consent?*

  • Media/Photo Release

    I hereby agree and consent to the use of any photograph, voice recording or videotape of the minor named above for promotional purposes on behalf of the People of God Summer Camp.  This may include, but not be limited to, brochures, web sites, videos and slide shows.  All rights and interest in the finished product are relinquished and all rights to payment or compensation are waived.

  • Do you consent?*

  • SPECIFIC MEDICATION CONSENTS

     

    Over the Counter Medications: 

    The People of God Summer Camp stocks the following over the counter medications.  While we do not necessarily stock name brands, the brand names of medications are indicated in parentheses for easy recognition:

    Acetaminophen Jr. strength chewables and children’s strength liquid (Tylenol)
    Ibuprofen Jr. strength chewables and children’s strength liquid  (Motrin or Advil)
    Diphenhydramine Liquid and tablets (Benadryl)
    Children’s Mucous Relief Cough (Cough Suppressant and Expectorant)
    Hydrocortisone 1 % cream
    Diphenhydramine cream (Benadryl)
    Triple Antibiotic Cream with Lidocaine (Neosporin plus pain relief)
    Cough drops 
    Calamine lotion or generic equivalent

  • Over the Counter Medication Consent:  Do you give permission for the camper named below to receive an age-appropriate dosage of over the counter medications for up to 24 hours while at camp?*

  • *** If an over the counter medication is administered for a full 24 hours, the nurses will communicate with parents/guardians before continuing to further  administer the medication

  • Epipen and/or Inhaler Consent* (if applicable):

  • Has the camper been taught how to self-administer his or her rescue inhaler?*
  • Do you give consent for the above named camper to carry and self-administer his or her rescue inhaler?*
  • Has the camper been taught how to self-administer his or her epipen or epipen Jr.?*
  • Do you give consent for the above named camper to carry and self-administer his or her own epipen or epipen Jr.?*

  • Adventure Trip Waiver, Consent and Release Form for 6th grade graduates only

     

    Intending to be legally bound hereby, I hereby freely, knowingly, and voluntarily consent to and give permission to my above named child, to participate in the canoe trip (or alternate activity dependent on the weather) held by the People of God summer camp and give my consent for my child to be transported by an adult staff member to and from this event.  I understand that in case of inclement weather that an optional activity will be chosen at the discretion of the People of God summer camp staff, and I give consent for my child to participate and to be transported to and from this alternate activity.

     

    I fully recognize that my child’s participation during this adventure trip (canoe trip/hike/other activity) can be dangerous, and hereby acknowledge that my consent to my child’s participation in any of these activities is voluntary and informed. I acknowledge that I have been advised of the risks to my child’s personal safety attendant to the canoe trip and other camp activities, and that, with a full and complete awareness of these risks, I consent to my child’s participation.  I acknowledge the staff has been fully, completely, and properly trained in the methods, practices, and techniques necessary and appropriate to any and all camp activities. I understand that the staff has taken every precaution to ensure the safety of my child.  I further acknowledge the staff has trained my child to properly participate in camp activities. Any use or nonuse of such methods, practices and techniques by my child shall, under no circumstances, result in claim against, or the imposition of any nature whatsoever, with respect to the People of God and its summer camp.

     

    As the parent of the above named child, I hereby fully waive, release and discharge the People of God, its agents, volunteers, employees, successors and assigns, from any and all rights, claims and actions, arising now and/or in the future, out of my child’s participation in the adventure trip and any and all other activities conducted by or under the auspices of the People of God.  I further agree to indemnify and hold harmless the People of God, from any claims arising out of any injury or harm my child may cause to the person or property of any and all individuals or groups during the course of their participation in this adventure trip.

     

  • Do you consent?*

  • Permission for ride home (if not picked up from camp by parent/guardian):   

     

    If these plans change you need to reach out to us ASAP, we will not be able to release your child to anyone that is not a parent or legal guardian, unless we have express permission to do so. Email us at pogcamp@gmail.com with any changes 

  • Will a parent or legal guardian be picking up your child from camp?*

  • I give my permission for the People of God staff to release my child, into the care of
     
    * for transportation home from camp.

  • Sign Below!!

  • Date*
     - -

  • Payment

    (The cost of camp is $430 per camper (for 6th graders: $30 additional for adventure trip), please only use the third option if it truly applies as available funds for financial aid are limited)
  • Which applies most? "At camp my child will be a..." or "I ..."*
  • prevnext( X )
        3rd - 5th Grade Graduate (following the 25-26 school year)
        $430.00
          
        6th Grade Graduate (following the 25-26 school year)

        Includes price for the adventure trip that takes place on the Thursday afternoon of camp, and the sixth-grade sendoff gift

        $460.00
          
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        Total
        $0.00
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