Young Women - Camp Registration Form

Transcription

1 Young Women - Camp Registration Form Tuesday July 24 - Saturday July 28 Be still, and know that I am God (D&C 101:16) Cost of Registration - $130 Young Women Due by Sunday, May 20 th Camper Name Date of Birth Parent Name Day Phone Home Phone Cell Address City Ward Emergency Contact (If parents are unavailable) Relationship to Young Woman Phone 2 nd Emergency Contact (If parents are unavailable) Relationship to Young Woman Phone Certification Level (circle one): 1 st level 2 nd level 3 rd level 4 th level 5 th level (ROPE) 6 th level (YCL) T-shirt size (circle one): 2XLarge XLarge Large Medium Small Youth L I hereby declare that I will abide by the camp rules and will conduct myself in a manner that is befitting a Latter-day Saint Young Woman. I have read and agree to the conditions of the Young Women s Camp Contract. (Young Woman s Signature) I hereby give permission for the above named minor to participate in the camp program. My daughter and I have read the YW Camp Contract and agree to its conditions. (Parent or Guardian Signature) YW1

2 YOUNG WOMEN S CAMP CONTRACT Dear Young Women and Parents/Guardian: Welcome to the wonderful world of Young Women s Camp! Chico Stake Young Women s Camp will be held at an LDS- owned camp called. Chico Stake shares it with 7 other stakes in the greater Sacramento area. The camp is about 2 hours from here just outside Downeyville. The camp has a small lake, an amphitheater area, and tenting campsites. There are indoor bathroom facilities and showers. There is a covered pavilion where most of the meals will be served, and a small kitchen area where most of the food preparation will take place. Its setting is in the beautiful forest with clean air, trees, and critters. The girls love to receive mail at camp. If you would like to mail a letter to your daughter, it needs to be at the post office no later than Wednesday morning the week of camp. The camp s address is: (YW s Name) LDS Young Women s Camp, Chico Stake General Delivery N. San Juan, CA The purpose of the camp experience is to help the young women learn basic survival skills in the outdoors and in emergency situations, but more importantly, it is our desire to give the young women an opportunity to grow closer to their Savior. A camping experience can help young women become more aware of the Lord s creations and the blessings the gospel brings into their lives. They can find joy in an outdoor setting that will strengthen their friendships and love for each other and build their testimonies in the gospel. In order to make this camping experience enjoyable for all who attend, there are certain rules and guidelines that must be followed. Here are our camp policies: ALL girls must participate in certification and must certify in their level to advance to the next level the following year. EVERYONE will attend devotionals, flag ceremonies, campfires and meals. DRESS STANDARDS: Shoes must be worn at all times. No shorts or tank tops, only modest swim suits (No bare midriffs). If questionable wear a t-shirt over swim suit. Swim suits are worn in the lake area only. JEWELRY - Only one pair of modest earrings is allowed in the earlobe. All other pierced jewelry must be removed. NO VISITORS: If a parent needs to come to camp for any reason except for an emergency, it needs to be pre-approved by the Stake Camp Director before camp. If a parent or guardian needs to pick up a girl from camp, she must check her out with her Ward Camp Director and the Stake Camp Director. NO INCENSE, CANDLES, LIGHTERS OR MATCHES NO ALCOHOL, CIGARETTES, DRUGS, OR ILLEGAL SUBSTANCES OF ANY KIND NO TOILET PAPERING OR ANY OTHER PRANKS NO Electronics! NO CELL PHONES, NO RADIOS, NO STEREOS, NO TAPE RECORERS, NO DVD PLAYERS, NO MP3 PLAYERS, NO IPODS (NOR ANYTHING LIKE UNTO THEM) OTHER RULES Items not addressed in this contract, but of concern will be resolved at the discretion of the Stake. If any of these policies or rules is broken, a girl may be sent home and may be put on camp probation the following year. These policies are not difficult to follow, and when one girl breaks the rules others may suffer and the spirit of camp is not what it could be. If each young woman abides by these policies, her week at camp will be the beautiful, spiritual, fun week that it is intended to be, and we want each girl there to enjoy it! Thank You, Your Chico Stake Camp Directors and Chico Stake YW Presidency Please read carefully: We understand and agree that the highest standards of conduct and dress will be expected of our daughter as a Young Women s Camp participant. We further agree that should our daughter for any reason violate or otherwise fail to maintain these standards, we will upon being notified, immediately make arrangements to have her picked up from camp. Young Woman s Signature Parent/Guardian s Signature YW2 Date Date

3 YOUTH / ADULT GIRLS CAMP REGISTRATION FORMS MEDICAL FORM Camper s Name Birthdate Age Ward Parent/Guardian/Adult Leader Name: Day Time Phone: Night Time Phone: Medical Insurance: Policy/M.R. Number: Primary Insured: Relation to camper: Primary Insured D.O.B.: Primary Care Physician: Phone #: PLEASE ATTACH A COPY OF THE FRONT AND BACK OF YOUR INSURANCE CARD AND IMMUNIZATION CARD TO THIS FORM. Consent to Treat: We, the undersigned, as the parents/legal guardians/myself of hereby give permission to attend and participate in the supervised Young Women s Camp program of the Church of Jesus Christ of Latter-day We authorize the camp nurse, camp director, qualified members of the camp staff, or driver of a vehicle to obtain first aid or other care to our said daughter/myself in the event of accident or illness. We further authorize said persons to take any provisions for medical and/or surgical care for our daughter/myself, including anesthesia, which may be deemed necessary or advisable by any licensed physician. We assume and shall be responsible for all medical costs and expenses in connection with the care and control of our said daughter except in so far as there is applicable insurance covering the same. In the event of an incident requiring medical attention we expect that every effort will be made to notify myself or the below named emergency contact. This authorization shall remain effective until the above-mentioned minor s return home from Girls Camp, unless revoked sooner in writing. Parent/Guardian/Adult Leader: Emergency Contact Name: Emergency Contact Name: Date: Phone: Phone: Part 1 YW3

4 Camper s Name CAMPERS MEDICAL HISTORY Please check if you presently have or ever had incurred any of the following: Poison Oak Fainting Diabetes Rheumatic Fever Heart Trouble Headaches Eye Problems Dizziness Back Problems Lung Disease Physical Disabilities Mental/Emotional Disorder Asthma Allergies Convulsions, Epilepsy Hay Fever Menstrual Problems ADD/ADHD Sleep Walking Hypertension Food Allergies Allergic to Insect Stings Irritable Bowel Syndrome High Blood Pressure Stomach Problems Please check if you have had any of the following in the past year: Ear Infections Any type of Surgery Any type of Injury Sore Throats Nose Bleeds Pink eye Head Lice Athlete s Foot Any type of skin rash No problems with any of the above Please explain any conditions checked above; list any treatment you are under, and describe the severity of the condition, and list any medications you are currently taking for that symptom in the section below. Any restriction of activity for medical reasons: Height: Weight: Baseline Blood Pressure: Date of last tetanus shot: (tetanus shot must be within the last five years) Please list any medications your daughter will be taking at camp. Any changes to this list MUST be communicated to the nursing staff before camp. All medication must be in original container with the camper s name on it Medication Reason for Med Time Med Due Dosage How Often? Part 2 YW4

5 Camper s Name GIRLS CAMP MEDICAL HISTORY, Cont d. We will be keeping the following over-the-counter medications in stock with the Health Care Supervisor. Please circle (Y)es or (N)o for each medication your daughter is permitted to receive: Ibuprophen/Motrin Y N Tylenol/acetaminophen Y N Advil Y N Benadryl/Diphenhydramine Y N Tums/antacid Y N Pepto Bismol Y N Midol Y N Kaopectate Y N Aleve Y N Any other OTC medications you do NOT want your daughter to receive: Allergies: Please list any medical or dietary allergies or restrictions & describe reaction (please note: special food requirements due to allergies or dietary restrictions, please contact Stake Camp Director. ALL MEDICATION MUST BE IN PROPERLY MARKED MEDICATION CONTAINER AND CHECKED IN TO THE CAMP NURSE UPON ARRIVAL AT CAMP! I understand that girl s camp requires camping & cooking outdoors and each level requires hiking (3rd and 4th level hiking with a backpack and camping away from base camp). My daughter has my permission to participate in all of the activities at camp. We have read and agree to the foregoing: Parent/Guardian Names: (Please Print) Parent/Guardian Signature: Date Able to hike (List Any Restrictions) Unable to participate in hike (List Reason) Part 3 YW5

6 Camper s Name Please circle the level of certification you will be this year: Level 1 Level 2 Level 3 Level 4 Level 5/YCL1 Level 6/YCL2 Adult Leader Adult Leader Certification: Current CPR Certificate (circle one) Y/N Current First Aid Certificate (circle one) Y/N Certificate expires Certificate expires SWIMMING PARTICIPATION Swimming ability: Non-swimmer Beginner Intermediate Advanced/lifeguard I give permission for my daughter/myself,, to participate in all swim and water activities at Girls Camp. She/myself is physically and medically able to do so, and agrees to abide by Water Front safety guidelines as explained by adult Camp Leaders. PARENT/GUARDIAN AUTHORIZATION: The heath history is correct so far as I know, and the person herein described has permission to engage in ALL prescribed camp activities, EXCEPT as noted by me. I understand I will be held responsible for any medications purchased on my daughters behalf. I also understand I am responsible to come pick my daughter up from camp should she become ill in any way. I hereby give permission to administer prescribed medication as well as over the counter medication, except as noted by me in the medical form. Furthermore, I release all camp leaders, including nursing staff, from any consequences that occur due to undisclosed prescription or over the counter medications sent to camp with my daughter. Parent/Guardian/Adult Leader Signature: Date: Part 4 YW6