Teen Work Study 2024

To be filled out ONLY by the Parent or Legal Guardian of the camper.

Camper Information

Each individual camper will need to apply separately.

Please select your 1st choice of retreat dates (please note; you will be notified if your choice of dates is unavailable)

June 7-9 July 19-21 I would like to attend BOTH dates

Camper's Name

Gender

Male Female

Date Format: (mm/dd/yyyy)

Birthdate

Age

14 15 16 17 18

Address

Mobile Phone

Church

Who do you want to bunk with? (Please pick 1 or 2 CAMPERS that are within one year of your age)

T-Shirt Size

Adult Size:: S Adult Size: M Adult Size: L Adult Size: XL Adult Size: XXL Adult Size: XXXL

Parent or Legal Guardian's Information

Please fill out all fields that are applicable to the camper's family.

Parent or Legal Guardian's Name

Relationship

Parent or Legal Guardian's address is the same as the Camper's address?

Yes No

Parent or Legal Guardian's Address (if different from camper)

Parent or Legal Guardian's Cell Phone Number

Parent or Legal Guardian's Email

This address will receive a confirmation email

Additional Parent or Legal Guardian's Name (if applicable; If not, write N/A)

Additional Parent or Legal Guardian's address is the same as the camper's address Yes No N/A

Additional Parent or Legal Guardian's address (if applicable)

Additional Parent or Legal Guardian's Cell Phone Number

Additional Parent or Legal Guardian's E-mail Address

Release

This section must be completed by the Parent or Legal Guardian in order for this application to be acceptable; unless the camper is 18 years or older.

1. I, the above named camper/or legal guardian thereof; consent to participating in the Harvest Christian Camp (HCC) 2024 Summer Camp Season.

I have read and agree to this release.

2. I agree that my participation or my child’s participation in Harvest Christian Camp is purely voluntary. I agree not to hold Harvest Christian Camp, House of Prayer Ministries, or any of its officers, staff, or volunteers liable or responsible for any loss or injury sustained arising in connection with his/her participation in Harvest Christian Camp activities.

I have read and agree to this release.

3. I acknowledge, for safety reasons, my child/teen cannot leave the HCC property without written permission on file in the office from the camp director. All campers under 18 yrs of age must be signed out by a parent/guardian or youth leader on the last day of camp.

I have read and agree to this release.

4. I, parent /guardian of the above named Child agree that Harvest Christian Camp shall have the right, but not the obligation to use my Child's photograph, likeness (including caricature, for their website, at any time and for any other purpose or materials the ministry deems necessary. The Child's name will not be used with the photos.

Yes Only in group photos please No, they cannot be included in any group photos.

Additional Emergency Contact Information

In a case of emergency, attempts will always be made to contact the parent/guardian first. This extra contact is who you would want us to contact if we are unable to connect with you (parent/guardian).

Emergency Contact

Emergency Contact Phone Number

Emergency Contact's Relationship to Camper (For example: grandmother, uncle, neighbor)

Medical Information

Health Insurance Company

Health Insurance ID#

Does your camper have up to date vaccinations? (tetanus within last 5 years)

Yes; up to date No, not all are up to date

Does camper have any allergies (food, medication, environmental)?

Yes No

Does camper have any special mental, health, or behavioral problems?

Yes No

Does the camper have any functional limitations (walking, running, jumping, dancing, lifting, etc.)?

Yes No

Is the camper presently under physicians or psychiatric care?

Yes No

Is your child currently on any prescribed or over the counter medicines (including inhalers)?

Yes No

If you said yes to any of the above questions take the section below to give details to each question that was asked. (which allergies, names and doses of medication, mental, health or behavioral problems, functional limitations, and/or description of physician or psychiatric care. ) If you said no, then write N/A

List any recent illness, injuries, or hospitalizations. If no, then write N/A

Any additional medical information you feel would be important to share with us. If none, then write N/A

****ATTENTION****

Please send to camp with your child their inhaler and nebulizer, even if they have not used it recently. Also the camp will only have basic first aid and medication on site. Send to camp with your child any medicines you will expect them to need. We will only dispense over the counter medicine when absolutely necessary. Please note that all campers will have their heads checked for lice during registration. We desire for your child to have a healthy and safe camping experience.

I have read and will send to camp any medication my child may need during their stay.

Do we have permission to give your child Tylenol, Motrin, Ibuprofen, Pepto Bismol, Cough Drops, Loratadine (for Allergies), or Benadryl (for bee stings)?

Yes No

We have read and understand the forgoing requests and release. IN WITNESS WHEREOF, we have executed this request and release

Is the person filling this out the legal guardian? If you click yes you are stating that you are the parent or legal guardian of the above named camper. (If you are the camper and are 18 years or older you may sign this form)

Yes No

Parent or Guardian's Signature. (Please type your first and last name as this will be your digital signature)

Unnamed Label

Option Option Option

Description

June 5-7 (option 1) / July 17-19( option 2)

AGES 14 through 12th grade

Registration Starts at 4:30 pm Wednesday

Registration Fee $55 per retreat
(Application Deadlines:with full payment)
May 29th (1st retreat choice)
July 10th (2nd retreat choice)

Early Bird Rate $40 per retreat
(Application Deadline is MAY 1st with full payment)

Applicants must submit application and full payment by registration deadlines or a $25 late fee will be charged.
(This is necessary due to the increased cost of food etc. for campers added late.)

Campers that apply after June 1st may not get the correct size T-shirt, or shirts may even run out.

Teen Work Study 2024

Description

Please Fix the Following