Preteen Camper Application

Encountering God Camp- Pre-Teen Camp

June 18-23 For children ages 8-12 years. Registration deadline June 4th
Please fill the form below to register your child for the Encountering God Preteen Camp.

Protecting your privacy - The information we seek allows us to manage risk and provide reasonable care at our camps. We are careful to keep any information confidential. Any information is only given to team members who need it on camp.

We will not use this information for any other purposes.
Camper Contact Details
Child's Full Name

First NameLast Name
Date of Birth

MonthDayYear
Age
Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Details

Home Number

Mobile Number

CityState / Province

Postal / Zip Code
Excitement Level for Camp
Home Church
Pastor's Name
Dietary Details- Are there any dietary, food allergies or nutritional requirements that our camp cooks need to be aware of?

Other
T-Shirt Size
Medical Information

Camp does not supply medication. Please feel free to provide any medication your child needs in a labelled container/bag. This is kept locked in our First Aid Room and only given out by our Camp Staff.
Do you expect the camper will need to take any medication during Camp?

Other
If yes, please list any medication you are supplying with dose and frequency. Please ensure that it is well marked and reason for the medication (this helps us understand your child's needs).
Please list any allergies your child has, including food
Is there any reason the camper should be limited during any activities? please explain
Specific Medical Conditions
Are there any conditions requiring special attention that we should know about? (mental or physical limitations) If yes, please provide details so we can best support your child.
Is the Camper prone to sleep walking?
Is the Camper prone to bed wetting?
Please provide your health insurance provider name, policy number, and phone number
Please upload a copy of your insurance card, front and back

Upload a File

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Activities Participation
Can the camper swim?
Are there any specific activities that you do not wish the camper to participate in like zip lining, swimming, high ropes course, canoeing, or water slide? If yes, please specify:
Parent/Caregiver Contact Details
Mother's Name
Father's Name
Address if different from above

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Phone Number
E-mail
Emergency Contact During Camp

In case of emergency, please list two emergency contacts if we are unable to contact the parent/caregiver.
Name
Person One:
Relationship to Camper
Contact Details

Phone Number

Mobile Number

CityState / Province

Postal / Zip Code
Name
Person Two:
Relationship to Camper
Contact Details

Phone Number

Mobile Number

CityState / Province

Postal / Zip Code
Camper Access & Pick Up

To ensure the on-going safety of the camper, please indicate any individuals who DO NOT have access to the camper, either due to custody issues or court orders.
Name and relationship to Camper:
Who will be picking up the Camper on the last day of camp?
Name and Relationship to Camper:
Spiritual Information
Has the camper accepted Jesus as Savior?
Approximately how many years has the camper followed Jesus?
Has the camper been baptized?
Consent & Agreements
Your Agreement with us: I give permission for the named camper to attend camp. They agree to observe the rules and routines of camp and to participate in the program. I acknowledge that certain risks and hazards are inherent in outdoor activities and cannot be eliminated without destroying the unique character of the outdoors. However, I understand that Encountering God Camps will indentify foreseeable risks or hazards and implement correct management strategies to eliminate, isolate or minimize those hazards. The safety of each individual is of the utmost importance.

In the event of an emergency, I authorize the camp to obtain medical advice, assistance and/or treatment including emergency treatment that they deem necessary. I accept the responsibiity for payment of any medical, transportation or other related expenses associated with treatment.

Camp fees are non-refundable.
Consent: As a condition of being permitted to attend the COG7 Encountering God Camp at Wesleyan Woods in Vassar, MI between the dates of June 18-23, 2017, the undersigned hereby agrees to instill a safe environment for the campers. I agree to assume responsibility for any risk of personal injury or loss, or damage to property, where warranted. I hereby release the Church of God 7th Day and its employees, camp staff and volunteers from any lawsuits and waive all claims, demands, or actions for any personal injury, loss, and property damage.

Attendance at Camp is only guaranteed when an attendance form is completed, returned and full camp fees are paid.

By clicking "Submit" below, you agree to the Terms and Conditions above.
Electronic Signature of Parent or Guardian
Camp Fees & Payment
FULL Registration: $200.00
Family Discount: 10% off total price (register 2 or more siblings)

All checks are payable to: Church of God 7th Day.

Send checks to Encountering God Camp, 2998 Lyons Rd, Owosso, MI 48867
How will you be paying for camp? Please check all that apply
PayPal

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USDEGC Camper Registration
If paying with PayPal you will be redirected to PayPal once you check out. You can either pay with credit card, debit card, or PayPal. There is a $1.50 processing fee for using this option.
This application may also be printed out and mailed to:

Lyle Kendrick

2998 Lyons Rd

Owosso, MI 48867
Should be Empty:

Encountering God Camp- Pre-Teen Camp

Camper Contact Details

Medical Information

Activities Participation

Parent/Caregiver Contact Details

Emergency Contact During Camp

Camper Access & Pick Up

Spiritual Information

Consent & Agreements

Camp Fees & Payment

PayPal