PEAK EXPERIENCE RE-INVENTED

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1 PEAK EXPERIENCE RE-INVENTED Get set for a great time at PEAK EXPERIENCE RE-INVENTED on July 26 th 31 st. We are really excited you re going to be at camp with us! Here are some things to know about camp: Check-in is from 3-3:30 pm on July 26th. Please let us know if you ll be delayed. Camp Ends at 9:00 am on July 31st. Campers need to be picked up at that time. Here is a list of many of the things you will want to bring with you to camp. Pillow and a sleeping bag or sheets & blankets Personal items like soap, shampoo, deodorant, toothbrush, toothpaste, etc. One piece, unrevealing swimsuit, (or a dark t-shirt to cover a two piece suit) Beach towel, bath towels, wash cloths Layers of clothing for warm and cool weather. Closed-toe shoes for active games. Jacket and flashlight Bug spray and sunscreen Bible with your name in it A notebook to get new friend s addresses Cash for the Camp Store to buy souvenirs and snacks Spirit of fun and adventure!! We ll have activities to keep you busy day and night. Campers are not allowed to have a cell phone or other electronic equipment in their possession during camp. Leave them home or turn t in at check-in. Additionally pets, fireworks, tobacco products, alcoholic beverages and knives are not allowed on site. The welfare of all of our campers is our top priority. In an effort to prevent the spread of infection and influenza (illness), please keep your camper home if s/he has a fever, is suffering with a headache, or does not feel well. We will make every effort to reschedule into a different camp or refund your money in full. The Camp has a medication administration policy, which requires that all prescription and nonprescription medications for campers and adults be gathered into a safe place during "Check In". For the safety of everyone, no medication can be kept in the cabins. Having the medications in one place prevents any accidents. If your medications are in a med-cassette and you are able to bring that to camp, it would be most helpful. A Ministry Team member will supervise the campers while the campers take their own medications at the prescribed times. There is a form for self-administration of medications and a health form enclosed. Please have your parent/guardian complete and return them to the Camping Office: Dakotas United Methodist Camps, PO Box 460, Mitchell, SD prior to camp. s can be sent to campers by opening a Bunk 1 account. Click on the Bunk 1 tab on our website s home page for more information. Letters from home can be mailed to campers using the following format: PEAK EXPERIENCE RE-INVENTED (Campers Name) Storm Mountain Center Storm Mt Rd Rapid City, SD If you have registration questions, please contact the Camping Office at or by at diane.weller@dakcamps.org. For program or site questions, please contact Storm Mountain Center at See you at Camp, Eric and Denise Van Meter, Camp Deans

2 Scott Jensen, Director Storm Mt Rd Rapid City, SD Phone: Fax: From I 90 east of Rapid City, go left (south) at exit 61(Hwy 79 & 16A) following the signs toward Mt. Rushmore. (Using this exit will skirt Rapid City completely. Follow the directions below at exit 57 if you wish to travel through Rapid City.) At the junction of Hwy 16A and Hwy 16 (the waterslide will be on your left) turn left onto Hwy 16. Proceed approximately 8 miles where you will see two exits to the left for Rockerville. About 1/2 mile past the second Rockerville exit turn right onto Silver Mountain Road. Proceed approximately 1/3 mile to Storm Mountain Road on your right. (Look for the large brown Storm Mountain sign). Follow Storm Mountain Road 1.7 miles down to camp. It is a winding Forest Service road. Please be aware other vehicles may be leaving camp as you enter camp. From I 90 west of Rapid City go right at exit #57 on Hwy 16, following the signs through Rapid City. You will be coming out of Rapid toward the south. Look for the two exits to Rockerville and follow the directions from the Rockerville exit in the paragraph above. CANCELLATION POLICY: Cancellations in writing via or US mail at least days prior to the start of camp will receive a full refund minus a $45 processing fee. No refunds will be issued for cancellations less than 21 days prior to the start of camp except in the case of illness or family emergency. A written request for the refund in the case of illness or family emergency is still needed.

3 ADDITIONAL HEALTH HISTORY FORM FOR CHILDREN, YOUTH, AND ADULTS ATTENDING OFFSITE CAMPS OR CAMPS WITH PHYSICALLY CHALLENGING ACTIVITIES (rock climbing, rappelling, high ropes course, whitewater rafting, kayaking, etc.) The information on this form is not part of the participant acceptance process but is gathered to assist in identifying appropriate care. Please provide complete information to make us aware of needs. Any changes to this form should be provided to the camp dean upon arrival at camp. Camp Name: Dates of Camp: P O Box 460 Mitchell, SD Phone: Name: Last First Middle Insurance Information: Is the participant covered by family medical/hospital insurance: Yes No If so, indicate carrier or plan name: Group # Photocopy of front and back of health insurance card must be attached to this form. The camp provides supplementary insurance for all campers and volunteers. This insurance is secondary and is limited to accidents that may occur while at camp. All claims must be submitted to the camper s or volunteer s insurance company and the camp s insurance company. IMPORTANT ALL SECTIONS MUST BE COMPLETE FOR ATTENDANCE Parent/Guardian Authorizations: This health history is correct and complete as far as I know, and the person herein described has permission to engage in all camp activities except as noted. I hereby give permission to the camp to provide routine health care, help with selfprescribed medications, and seek emergency medical treatment including ordering x rays or routine I agree to the release of any records necessary for treatment, referral, billing, or insurance purposes. I give permission to the camp to arrange necessary related transportation for me/my child. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the camp to secure and administer treatment, including hospitalization, for the person named above. This completed form may be photocopied for trips out of camp or offsite for those trips that leave the Signature of parent or guardian or adult PrintedName: Date: Please complete both pages of this

4 GENERAL QUESTIONS (Explain "yes" answers below) Please circle either Yes or No Has/does the 1. Had any recent injury, illness or infectious ease? Yes No 16. Ever had back Yes No 2. Have a chronic or recurring illness/ Yes No 17. Ever had problems with joints (e.g., knees, ankles)? Yes 3. Ever been Yes No 18. Have an orthodontic appliance that he/she 4. Ever had Yes No to Yes No 5. Have frequent Yes No 19. Have any skin problems (e.g., itching, rash, acne)? Yes 6. Ever had a head Yes No 20. Have Yes No 7. Ever been knocked Yes No 21. Have Yes No 8. Wear glasses, contacts or protective eye Yes No 22. Had mononucleosis in the past 12 Yes No 9. Ever had frequent ear Yes No 23. Had problems with Yes No 10. Ever passed out during or after Yes No 24. Have problems with Yes No 11. Ever been dizzy during or after Yes No 25. If female, have an abnormal menstrual Yes No 12. Ever had Yes No 26. Have a history of bed Yes No 13. Ever had chest pain during or after Yes No 27. Ever had an eating Yes No 14. Ever had high blood Yes No 28. Ever had emotional difficulties for 15. Ever been diagnosed with a heart Yes No professional help was Yes No Please explain any "yes" answers, noting the number of the questions. (Use a separate sheet of paper Use this space to provide any additional information about the participant s behavior and physical, emotional, or mental health about which camper personnel should be aware: Name of family Address: Phone:

5 PERMISSION TO WITNESS AND ASSIST THE SELF-ADMINISTRATION OF PRESCRIPTION MEDICATION NAME OF CAMPER: NAME OF CAMP EVENT: As the parent or guardian of the camper named above, I hereby acknowledge that my camper will be responsible to selfadminister the prescription medication, which he/she brings to camp. I accept the responsibility for providing a sufficient amount of medication in the original container for the duration of the camp and for accurately informing the camper and camp personnel of instructions for self administration. I acknowledge that no camp personnel can administer any prescription drug but can only assist in self administration. Assistance with self administration means helping with one or more steps in the process of taking medications but not actual administration. Assistance may, but does not necessarily, include opening the medication container, reminding the camper of the proper time to take the medication, helping to remove the medication from the container and returning the medication container to proper storage. I hereby release the camp, its personnel, volunteers and the Dakotas Annual Conference of the United Methodist Church of any and all liability associated with the self administration of drugs prescribed to my child. Parent/Guardian Date