SIMC April 24-26 Teen Camp Registration 2026

SIMC Camps Registration 2026
Southwest Indian Ministries
14202 N 73rd Ave., Peoria, AZ 85381
*Please read the entire form carefully. Thank you!
Age 13 to 18 Camp
April 24-26, 2026
Camper's First and Last Name*
Male (M) or Female (F)*
Have you attended camp before?
Current Age*
Date of Birth*

MonthDayYear
Date
Grade Level in 2025-26
Text #*
Format: (000) 000-0000.
Email*
example@example.com
Mailing Address*

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:*
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 Chapelrock (1131 Country Club Dr., Prescott, AZ 86303)
Medical Insurance Company*
(Group Number)*
(Policy number)*
No(If yes, explain):
No(If yes, explain):
No(If yes, explain):

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 & 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, 14202 N 73rd Ave., Peoria, AZ 85381 before Friday, April 10, 2026.

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 73^rd 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:

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Parent/Guardian Participant Agreement, Release, and Medical Authorization
Southwest Indian Ministry Camps (SIMC) • World Gospel Mission (WGM) • Camp Pinerock • Chapel Rock Camp
Parent Summary (Please Read)
We want your child's camp experience to be safe, meaningful, and fun. This agreement gives permission for your child to participate in camp activities hosted by Southwest Indian Ministry Camps (SIMC) and partner camps including Camp Pinerock and Chapel Rock. It explains that camp activities may include adventure programs and recreation that involve inherent risks. It authorizes camp staff to provide emergency medical care if needed, allows staff to administer medications you approve, and grants permission for photos or videos to be used for ministry purposes. By signing below, you acknowledge these risks and agree not to hold the camps or their staff legally responsible for injuries or emergencies that may occur during participation. Please read the full agreement carefully before signing.
Parent/Guardian Participant Agreement
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
- Chapel Rock Camp
- and any affiliated or partner ministries.
Activities may include, but are not limited to:
- recreation and group games
- swimming and water activities
- field trips and transportation
- instructional programs and classroom activities
- climbing walls, ropes courses (high and low)
- zip lines
- archery, paintball
- kayaking, rappelling, rock climbing
- team-building initiatives and outdoor adventure activities.

I understand that these activities involve inherent risks that cannot be eliminated, even with proper supervision and safety precautions.
On behalf of myself and my child, I knowingly and voluntarily assume all risks, whether known or unknown, foreseeable or unforeseeable.
I also understand that certain activities, such as high ropes elements, may have participant weight requirements (generally between 45 and 275 pounds) and participation may be limited by camp staff for safety reasons.
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 (SIMC)
- World Gospel Mission (WGM)
- Camp Pinerock
- Chapel Rock Camp
- and their respective owners, officers, directors, employees, volunteers, agents, representatives, and affiliated entities
(collectively referred to as 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 negligence.
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.
3. Rules, Conduct, and Early Dismissal
I understand that my child is expected to follow all camp rules, safety guidelines, behavioral expectations, and staff instructions.
Camp leadership reserves the right to limit or terminate participation if necessary for safety, discipline, or program integrity. Early dismissal may occur without refund.
4. Medical Authorization & Emergency Care
I authorize SIMC, WGM, Camp Pinerock, Chapel Rock Camp, and their designated staff to provide routine first aid to my child.
If illness or injury occurs and I cannot be reached, I authorize camp leadership to obtain emergency medical, dental, surgical, or hospital care as deemed necessary by a licensed medical professional.
This authorization includes diagnostic testing, anesthesia, and hospitalization if medically advisable.

5. Financial Responsibility for Medical Care
I accept full financial responsibility for any medical treatment provided to my child that is not covered by insurance, tribal health coverage, or other programs.
6. Medication Authorization
I authorize camp staff to administer prescription provided by me and and approved over-the-counter medications documented on camp medical forms.
I understand:
- medications must be turned in during registration
- prescription medications must be in the original labeled container
- medications will be administered according to camp policy and dosage guidelines.
7. Media & Likeness Release
I grant permission for my child's first name, image, voice, or likeness to appear in photographs, video recordings, or other media captured during camp activities.
These materials may be used for educational, promotional, or ministry purposes by:
- Southwest Indian Ministry Camps
- World Gospel Mission
- Camp Pinerock
- Chapel Rock Camp
- affiliated ministries
without compensation or additional permission.
8. Governing Law & Venue
This agreement shall be governed by the laws of the State of Arizona, and any legal action arising from this agreement shall be brought 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.
- I have read and fully understand this agreement.
- I sign this document voluntarily and with full knowledge of its legal significance.

Participant & Parent Information
Emergency Contact Person

First NameLast Name
Emergency Contact Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Signature

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SIMC Camps Registration 2026

Cost & Payment Information

Camper Expectations

Parent/Guardian Participant Agreement, Release, and Medical Authorization

Parent Summary (Please Read)

Parent/Guardian Participant Agreement

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 Authorization

7. Media & Likeness Release

8. Governing Law & Venue

9. Parent/Guardian Certification

Participant & Parent Information