2018 Camper Registration Form

2018 Camper Registration

Camp David of the Ozarks is an Angel Tree camp for children with one or both parents in prison. Do not register your child if they do not have a parent in prison, unless they are an alumni camper who has had a parent in prison in the past. Each part of our program is uniquely designed to help children dealing with parental incarceration.
**MUST FILL OUT SEPARATE REGISTRATION FORMS FOR EACH CHILD.
Camper's Full Name *

First Name Last Name
Nickname
Age *
Birth Date *

Month Day Year
Gender *

Male Female
First Time Camper *

Yes No
Years at Camp
Name of Parent/ legal guardian *

First Name Last Name
E-mail

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Home Phone *

- Area Code Phone Number
Cell Phone

- Area Code Phone Number
Work Phone

- Area Code Phone Number
Emergency Contact: Relative *
Phone Number *

- Area Code Phone Number
Emergency Contact: Close Friend
Phone Number

- Area Code Phone Number
Number in Household
Annual Household Income
Check the camp your child would like to attend:
Note: Select only one week per child. Junior Camps- If the week you selected is already filled up, we will contact you to offer an alternative. These camps are filled by a first come, first served basis!
Senior Camp (Youth ages 13-16)

Senior Boy's Camp - June 11 - 15 Senior Girl's Camp - June 18 - 22
Junior Camp (Youth ages 8-12)

Junior Boy's Camp - June 25 - 29 Junior Girl's Camp - July 9 - 13 Junior Boy's Camp - July 16 - 20 Junior Girl's Camp - July 23 - 27
Health Record
Camper's Doctor's Name *

First Name Last Name
Phone Number *

- Area Code Phone Number
Health Insurance or Medicaid Number
Immunizations are up to date? *

Yes No
Date of last Tetanus *

- Month - Day Year
Recent Operations? *
Does the camper have any allergic reactions to food, drugs, poison ivy, or insect stings? If so, please describe.
Special Considerations

Sleepwalk Bed Wetting Fainting Epilepsy Diabetes Hay Fever Asthma ADD/ADHD ODD Other
Explain any of the above if applicable:
List any childhood diseases:
I give permission for my child to receive:

Tylenol Ibuprofen Allergy Medication Antacid Anti-itch cream Other
We have allowed 6 blocks for medications. If your child doesn't have any medications, just leave them blank. If your child has more, please contact the office. Medications must be in their original packaging for us to administer them at camp.
1. Medication:
Dosage:
Directions:
2. Medication:
Dosage:
Directions:
3. Medication:
Dosage:
Directions:
4. Medication:
Dosage:
Directions:
5. Medication:
Dosage:
Directions:
6. Medication:
Dosage:
Directions:
Medical Permission & Release
"I accept the risks involved in camp activities and do hereby release Camp David of the Ozarks, and all staff and volunteers, from any and all claims for bodily and personal injuries or death sustained by my child, whether such injury occurs on or off the camp property. I give permission for Camp David of the Ozarks to secure emergency medical and surgical treatment, and routine, non-surgical medical care for my child while at camp. I understand that should my child become ill I may need to make arrangements to pick them up."
Parent/Guardian Signature: *
Relationship to Child: *
Date signed: *

- Month - Day Year
Inmate Verification

Angel Tree requires this inmate information to verify qualifications for camp scholarships. Camp David will not use this information for any other reason.
Inmate Name *

First Name Last Name
Relationship to Camper *
Prison *
City *
State *
If parent/step-parent was released from prison - Date or year of release:
Child knows parent is incarcerated:

Yes No
Scholarship Requested

Full scholarships are available, but if you are financially able to pay for all or part of the fee, we request you do so.
Scholarship Request: *

I am paying the full cost of the camp (I will pay $200) Partial Scholarship of $50 (I will pay $150) Partial Scholarship of $100 (I will pay $100) Partial Scholarship of $150 (I will pay $50) I am requesting a full scholarship of $200
MAKE ONLINE PAYMENT
Transportation

If necessary, Camp David can provide transportation for your child from pick-up points in several cities.
Note: Camp starts at 11:30am on Monday and ends at 1:00pm on Friday. You will receive a letter confirming your transportation plan one week prior to your child's week of camp!
Your Transportation Plan: *

I will provide transportation for my child to and from camp My child(ren) will need to ride the van from my nearest pick-up spot
Select the city pick-up point that is nearest to you:

St. Clair St. Louis Jefferson City Rolla St. Robert
Parental Permission & Release

This must be signed in order to register your child!
"I understand that while attending Camp David of the Ozarks my child may be involved in various activities including, and not limited to swimming, horse rides, obstacle course, and other traditional camp activities.

I understand the mission for Camp David of the Ozarks is to provide a Christian Camp where one can experience love, find hope, and grow in a relationship with Jesus Christ. I do hereby grant permission for my child to attend camp and participate fully in all camp activities.

I have instructed my son/daughter to obey the rules of Camp David of the Ozarks. I understand that should my child become very disruptive I will need to make arrangements to pick them up.

I also give permission to Camp David of the Ozarks to use camp pictures of my child in promotional and sponsorship material."
Parent/Guardian Signature: *
Relationship to Child: *
Date Signed: *

- Month - Day Year
Enter the message as it's shown *
*For registration questions: Call: 573-364-2786 or email: secretary@campdavidozarks.org
Should be Empty:

2018 Camper Registration

Health Record

Medical Permission & Release

Inmate Verification

Scholarship Requested

Transportation

Parental Permission & Release