2019 - gncnc.orgthe sugar shack will be open a specified time each day when campers may purchase...

2
CAMP GOOD NEWS 2019 DAY & OVERNIGHT CAMP 55 Years of Camping Sponsored by: GOOD NEWS CLUB, INC. OF NORTHUMBERLAND COUNTY CHILD EVANGELISM FELLOWSHIP 53 Blue Hill, Northumberland, PA 17857-8667 (570) 473-9400 gncnc.org • [email protected] Affiliated with CHILD EVANGELISM FELLOWSHIP OF EASTERN PA, INC. Anna Bradigan, Director Shannin Soulsby, Ministry Assistant Janet Reynolds, Part-Time Worker THE ENTIRE FORM MUST BE COMPLETED, SIGNED, AND SENT WITH A $125 NON-REFUNDABLE ($30 for day camp) FEE. CLIP & SEND THIS PAGE WITH THE REGISTRATION FEE TO: GOOD NEWS CLUB, INC. 53 BLUE HILL, NORTHUMBERLAND, PA 17857-8667. Payments accepted in cash or check, made payable to: GOOD NEWS CLUB, INC. Your child’s registration will be considered by the date it is received at our office. PLEASE CHECK WEEK(S) ATTENDING A camper may attend one week of Day Camp and/or one week of Overnight Camp. Northumberland Day Camp (July 8-12) Overnight Camp (July 28-August 3) Northumberland Day Camp (July 15-19) Overnight Camp (August 4-10) Camper’s Name: Last________________________________________ First _______________________________________ Male Female Date of Birth: ______/______/_______ Age on first day of selected camp 2019 ____________ Entering Grade ___________ in September 2019 (MM/DD/YYYY) Address: Street _______________________________ City _______________________________ State _________ Zip +4 __________________ Home phone: (______) _______-________ Cell phone: (_______) _______-_________ E-mail ___________________________________________ Pastor and Church Name, if any _______________________________________________________________________________________________ For the protection of your child, we require a signed note if you are designating someone else to pick your child up from camp. CAMPER HEALTH FORM Camper’s personal health insurance is primary; camp insurance is excess Family Health Insurance _____________________________________________________ Name of Policy Subscriber ___________________________ Policy # _____________________________________ Group # _______________________________________________________________________ Family Physician ____________________________________________________________________ Phone: (_______) ________ - _______________ Health HistoryPlease check if your camper has been previously diagnosed with any of the following: Acid Reflux Dyslexia Gastrointestinal Issues Heart Issues Recurrent Ear Infections Respiratory Issues (Constipation, Abdominal Pain) (Pneumonia, Bronchitis, Asthma, Sinusitis) Epilepsy/Seizures Kidney/Bladder Issues Skin Issues Date of Last Tetanus Shot ___ /____ /_______ Are all other immunizations current? __________ Other: ______________________________________________________________________ Please note that our camp is open to all boys and girls; however, our program is not conducive to, nor do we have the staff and ability to handle severe health issues or cases of learning or physical disability that would otherwise require a full-time TTS or other special caregiver. Current HealthPlease check if your camper experiences on a recurring basis or has been recently diagnosed with any of the following: Bed Wetting Gastrointestinal/Stomach Issues Asthma or other Respiratory Issues Allergies: ________________________________ Hypertension Social/Emotional Problems Skin Problems Dietary Restrictions: ___________________________________________ Sleep Walking Has Menstruated Has Been Informed About Menses Other ______________________________________________ Medications _________________________________________________ Reason ______________________________________________________ All medications MUST be brought in original prescription containers labeled with instructions and turned into the nurse upon arrival. Parent’s Authorization: To my knowledge, the information provided on this form is correct and I give permission for my child, named above, to attend the camping program(s) checked on the application form above and to participate in all camp activities. I give permission for my child to be included in any photographs, video, and/or website and other print and electronic publications that may be used in GOOD NEWS CLUB, INC. ministry promotion. While my child is at Camp Good News, I authorize the camp nurse to administer the above listed prescription medications as well as dose appropriate non-prescription medications and treatments necessary in the best interests of my child. I recognize that during the course of the operation of the camp program, unforeseen conditions may develop including accidental injuries and illness. Therefore, in the event of such injuries affecting my child, I authorize the nurse(s) at the camp, or in their absence, a member of the camp staff, to administer such first aid and emergency treatment and care as in their opinion may be deemed necessary and advisable. In the event I cannot be reached, I also hereby appoint the camp director and the camp nurse on duty to act in my stead to give consent for transport to a medical facility and order injections, anesthesia, surgery or other necessary procedures for my child. I understand I am responsible for the cost of any such medical treat- ment, whether I have insurance coverage on my child or not. I hereby release GOOD NEWS CLUB, INC. OF NORTHUMBERLAND COUNTY, its committee, and camp staff from any and all liability in the event of any accident or misfortune that may occur to my child or as a result of the use of their best judgment under the circumstances that may be present. I hereby waive any right that I, or my child, may have to sue GOOD NEWS CLUB, INC. or any of its employees or board, or camp staff, paid or volunteer, as a result of any and all accidental injuries, and damages or losses sustained by my child while participating in the camp program and any activities associated with camp. PRINT Parent/Guardian Name ________________________________ Parent/Guardian Signature______________________________ Date _______ Emergency Contact’s Name _________________________ Contact’s Phone # _________________________ Relationship to Camper _____________ Date received __________ Amount received _________ Amount due ____________ OFFICE USE 2019 REGISTRATION FORM

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Page 1: 2019 - gncnc.orgThe Sugar Shack will be open a specified time each day when campers may purchase refreshments ($1/day). The campers will have an opportunity to give to the guest missionary

CAMP GOOD NEWS

2019 DAY & OVERNIGHT CAMP

55 Years of Camping

Sponsored by:

GOOD NEWS CLUB, INC. OF NORTHUMBERLAND COUNTY

CHILD EVANGELISM FELLOWSHIP

53 Blue Hill, Northumberland, PA 17857-8667

(570) 473-9400

gncnc.org • [email protected]

Affiliated with CHILD EVANGELISM FELLOWSHIP OF EASTERN PA, INC.

Anna Bradigan, Director Shannin Soulsby, Ministry Assistant Janet Reynolds, Part-Time Worker

THE

ENTI

RE

FOR

M M

UST

BE

CO

MP

LETE

D, S

IGN

ED, A

ND

SEN

T W

ITH

A $

12

5 N

ON

-REF

UN

DA

BLE

($

30

fo

r d

ay c

amp

) FE

E.

CLI

P &

SEN

D T

HIS

PA

GE

WIT

H T

HE

REG

ISTR

ATI

ON

FEE

TO

: G

OO

D N

EWS

CLU

B, I

NC.

53

BLU

E H

ILL,

NO

RTH

UM

BER

LAN

D, P

A 1

78

57

-86

67

.

Paym

ents

acc

epte

d in

cas

h or

che

ck, m

ade

paya

ble

to: G

OO

D N

EWS

CLU

B, I

NC.

You

r ch

ild’s

reg

istr

atio

n w

ill b

e co

nsid

ered

by

the

date

it is

rec

eive

d at

our

off

ice.

PLE

ASE

CH

ECK

WEE

K(S

) A

TTEN

DIN

G

A c

am

per

ma

y a

tten

d o

ne

wee

k of

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y C

am

p a

nd

/or

on

e w

eek

of

Ove

rnig

ht

Ca

mp

.

N

ort

hum

berl

and D

ay C

amp

(Ju

ly 8

-12

)

O

vern

igh

t C

amp

(Ju

ly 2

8-A

ugu

st 3

)

Nort

hum

berl

and D

ay C

amp

(Ju

ly 1

5-1

9)

Ove

rnig

ht

Cam

p (

Au

gust

4-1

0)

Cam

per

’s N

ame:

Las

t___

___

___

___

____

___

___

___

___

___

____

__

___

Fi

rst

___

___

___

___

___

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____

___

____

___

___

___

_

Mal

e

Fem

ale

Dat

e o

f B

irth

: __

___

_/__

___

_/_

___

___

A

ge o

n f

irst

day

of

sele

cted

cam

p 2

01

9 _

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teri

ng

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de

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Se

pte

mb

er

20

19

(

MM

/DD

/YYY

Y)

Ad

dre

ss:

Stre

et _

___

___

___

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____

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Cit

y _

____

____

___

____

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St

ate

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Z

ip +

4 _

___

____

____

___

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H

om

e p

ho

ne:

(__

___

_) _

____

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-___

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Cel

l ph

on

e: (

___

___

_) _

___

___

-___

____

__

E-m

ail _

____

____

___

___

___

___

___

____

__

____

___

____

__

P

asto

r an

d C

hu

rch

Nam

e, if

an

y _

____

___

____

___

___

___

___

___

___

____

___

___

___

___

___

____

__

____

___

____

___

___

___

___

___

___

____

___

___

_

For

the

pro

tect

ion

of

you

r ch

ild,

we

re

qu

ire

a s

ign

ed

no

te if

yo

u a

re d

esi

gnat

ing

som

eo

ne

els

e t

o p

ick

you

r ch

ild u

p f

rom

cam

p.

CA

MP

ER H

EALT

H F

OR

M

Ca

mp

er’s

per

son

al h

ealt

h in

sura

nce

is p

rim

ary

; ca

mp

insu

ran

ce is

exc

ess

Fam

ily H

ealt

h In

sura

nce

___

___

___

____

___

___

___

___

___

____

__

____

___

____

___

___

__

Nam

e o

f P

olic

y Su

bsc

rib

er _

___

___

___

___

____

___

__

___

__

Po

licy

# __

___

____

___

___

___

__

____

___

____

___

___

Gro

up

# _

___

____

___

___

___

___

___

____

__

____

___

____

___

___

___

___

___

___

____

___

___

___

Fa

mily

Ph

ysic

ian

__

___

___

___

____

____

___

___

___

___

___

____

__

____

___

____

___

___

___

___

___

__

Ph

on

e: (

____

___

) __

___

___

- _

____

___

____

___

H

eal

th H

isto

ry—

Ple

ase

chec

k if

yo

ur

cam

per

has

bee

n p

revi

ou

sly

dia

gno

sed

wit

h a

ny

of

the

follo

win

g:

A

cid

Ref

lux

D

ysle

xia

Gas

tro

inte

stin

al Is

sue

s

H

eart

Issu

es

Re

curr

ent

Ear

Infe

ctio

ns

Res

pir

ato

ry Is

sues

(C

on

stip

atio

n, A

bd

om

inal

Pai

n)

(

Pn

eu

mo

nia

, Bro

nch

itis

, Ast

hm

a, S

inu

siti

s)

E

pile

psy

/Sei

zure

s

Kid

ne

y/B

lad

der

Issu

es

Ski

n Is

sues

D

ate

of

Last

Tet

anu

s Sh

ot

___

/_

___

/___

___

_

A

re a

ll o

ther

imm

un

izat

ion

s cu

rren

t? _

___

___

___

Oth

er: _

___

____

___

___

___

___

___

____

__

____

___

____

___

___

___

___

___

___

____

___

___

__

Plea

se n

ote

that ou

r ca

mp is

open

to

all

boy

s and g

irls; how

ever

, ou

r pro

gram

is

not

con

duci

ve to,

nor

do

we

have

the

staff a

nd a

bili

ty t

o handle

sev

ere

hea

lth

issu

es

or c

ase

s of

learn

ing

or p

hys

ical

disabili

ty that

wou

ld o

ther

wise

require

a fu

ll-tim

e TTS o

r ot

her

spec

ial ca

regi

ver.

Cu

rre

nt

He

alth

—P

leas

e ch

eck

if y

ou

r ca

mp

er e

xper

ien

ces

on

a r

ecu

rrin

g b

asis

or

has

be

en r

ecen

tly

dia

gno

sed

wit

h a

ny

of

the

follo

win

g:

B

ed W

etti

ng

Gas

tro

inte

stin

al/S

tom

ach

Issu

es

A

sth

ma

or

oth

er R

esp

irat

ory

Issu

es

Alle

rgie

s: _

___

___

___

___

___

___

____

___

____

__

Hyp

erte

nsi

on

So

cial

/Em

oti

on

al P

rob

lem

s

S

kin

Pro

ble

ms

Die

tary

Res

tric

tio

ns:

___

____

___

____

___

___

___

___

___

___

____

___

___

_

S

lee

p W

alki

ng

Has

Me

nst

ruat

ed

H

as B

een

Info

rmed

Ab

ou

t M

ense

s

O

the

r __

___

____

____

___

___

___

___

___

____

__

____

___

____

_

Med

icat

ion

s __

___

___

___

___

____

____

___

___

___

___

___

____

__

____

__ R

easo

n _

____

___

___

___

____

___

____

___

___

___

___

___

___

____

___

___

_

All

med

icat

ion

s M

UST

be

bro

ugh

t in

ori

gin

al p

resc

rip

tio

n c

on

tain

ers

lab

eled

wit

h in

stru

ctio

ns

and

tu

rned

into

th

e n

urs

e u

po

n a

rriv

al.

Par

en

t’s

Au

tho

riza

tio

n:

To

my

kno

wle

dge

, th

e in

form

atio

n p

rovi

de

d o

n t

his

fo

rm is

co

rrec

t an

d I

give

per

mis

sio

n f

or

my

child

, nam

ed a

bo

ve, t

o a

tten

d t

he

cam

pin

g p

rogr

am(s

) ch

ecke

d o

n t

he

app

licat

ion

fo

rm a

bo

ve a

nd

to

par

tici

pat

e in

all

cam

p a

ctiv

itie

s.

I giv

e p

erm

issi

on

fo

r m

y ch

ild t

o b

e in

clu

de

d in

an

y p

ho

togr

aph

s, v

ideo

, an

d/o

r w

ebsi

te a

nd

oth

er p

rin

t an

d e

lect

ron

ic p

ub

licat

ion

s th

at m

ay b

e u

sed

in

GO

OD

NEW

S C

LUB, I

NC. m

inis

try

pro

mo

tio

n.

Wh

ile m

y ch

ild i

s at

Cam

p G

oo

d N

ews,

I a

uth

ori

ze t

he

cam

p n

urs

e to

ad

min

iste

r th

e ab

ove

lis

ted

pre

scri

pti

on

me

dic

atio

ns

as w

ell

as d

ose

ap

pro

pri

ate

n

on

-pre

scri

pti

on

med

icat

ion

s an

d t

reat

me

nts

nec

essa

ry in

th

e b

est

inte

rest

s o

f m

y ch

ild.

I re

cogn

ize

that

du

rin

g th

e co

urs

e o

f th

e o

per

atio

n o

f th

e ca

mp

pro

gram

, u

nfo

rese

en

co

nd

itio

ns

may

dev

elo

p i

ncl

ud

ing

acci

de

nta

l in

juri

es a

nd

illn

ess.

Th

eref

ore

, in

th

e ev

en

t o

f su

ch i

nju

ries

aff

ecti

ng

my

child

, I

auth

ori

ze t

he

nu

rse(

s) a

t th

e ca

mp

, o

r in

th

eir

abse

nce

, a

mem

be

r o

f th

e ca

mp

sta

ff,

to

adm

inis

ter

such

fir

st a

id a

nd

em

erge

ncy

tre

atm

ent

and

car

e as

in

th

eir

op

inio

n m

ay b

e d

eem

ed n

ece

ssar

y an

d a

dvi

sab

le.

In t

he

eve

nt

I ca

nn

ot

be

re

ach

ed,

I al

so h

ereb

y ap

po

int

the

cam

p d

irec

tor

and

th

e ca

mp

nu

rse

on

du

ty t

o a

ct i

n m

y st

ead

to

giv

e co

nse

nt

for

tran

spo

rt t

o a

med

ical

fac

ility

an

d

ord

er i

nje

ctio

ns,

an

esth

esia

, su

rger

y o

r o

ther

nec

essa

ry p

roce

du

res

for

my

child

. I

un

der

stan

d I

am

res

po

nsi

ble

fo

r th

e co

st o

f an

y su

ch m

edic

al t

reat

-m

ent,

wh

eth

er I

hav

e in

sura

nce

co

vera

ge o

n m

y ch

ild o

r n

ot.

I

her

eb

y re

leas

e G

OO

D N

EWS

CLU

B,

INC.

OF

NO

RTH

UM

BER

LAN

D C

OU

NTY

, it

s co

mm

itte

e, a

nd

cam

p s

taff

fro

m a

ny

and

all

liab

ility

in t

he

eve

nt

of

any

acci

den

t o

r m

isfo

rtu

ne

that

may

occ

ur

to m

y ch

ild o

r as

a r

esu

lt o

f th

e u

se o

f th

eir

be

st j

ud

gmen

t u

nd

er t

he

circ

um

stan

ces

that

may

be

pre

sen

t. I

her

eby

wai

ve a

ny

righ

t th

at I,

or

my

child

, may

hav

e to

su

e G

OO

D N

EWS

CLU

B, I

NC. o

r an

y o

f it

s em

plo

yees

or

bo

ard

, or

cam

p s

taff

, pai

d o

r vo

lun

teer

, as

a re

sult

of

any

and

all

acci

den

tal i

nju

ries

, an

d d

amag

es o

r lo

sses

su

stai

ned

by

my

child

wh

ile p

arti

cip

atin

g in

th

e ca

mp

pro

gram

an

d a

ny

acti

viti

es a

sso

ciat

ed

wit

h c

amp

. P

RIN

T P

aren

t/G

uar

dia

n N

ame

____

____

___

___

___

___

___

____

__

___

Par

en

t/G

uar

dia

n S

ign

atu

re__

____

___

____

___

___

___

___

___

__

Dat

e _

___

___

Em

erge

ncy

Co

nta

ct’s

Nam

e _

___

____

___

____

___

___

___

_ C

on

tact

’s P

ho

ne

# _

___

___

___

___

____

____

___

_ R

elat

ion

ship

to

Cam

pe

r __

___

__

____

__

Date received __________

Amount received _________

Amount due ____________ OFFIC

E U

SE

2019

REGIS

TRAT

ION F

ORM

Page 2: 2019 - gncnc.orgThe Sugar Shack will be open a specified time each day when campers may purchase refreshments ($1/day). The campers will have an opportunity to give to the guest missionary

Overnight Camp Registrations limited to 60 per week

Preregistration recommended by July 20

What Parents Can Expect . . .

Who Children ages 8-12

When July 28-August 3 or August 4-10

Registration begins at 3:30 p.m. Sunday afternoon. The week begins with supper at 5:30 p.m. Campers are dismissed on Saturday morning following the award program which begins at 9:00 a.m. Family and friends are invited to attend!

Where Mountain View Bible Camp

2671 Snydertown Road Danville, PA 17821

(Approximately 7 miles from Sunbury)

How Much $335

A $125 non-refundable fee is required with a completed registration form per child. The remain-ing balance of $210 is due the FIRST DAY OF CAMP.

Only the registration fee is due when sending the registration form; however, full payment is always appreciated when convenient. Balance of fees are due WHEN REGISTERING ON SUNDAY.

Camp Store The Sugar Shack will be open a specified time each day when campers may purchase refreshments ($1/day). The campers will have an opportunity to give to the guest missionary during the week from their leftover change.

Camp Good News is dedicated to providing a well-rounded program for your child. While carrying out the Native American Indian theme, we endeavor to

meet the spiritual, mental, social, and physical needs of each camper.

Also:

Continuous supervision for your child by trained staff

Camp staff are screened by GOOD NEWS CLUB, INC. and the adult staff are required to submit copies of their clearances

A nurse is always present

A qualified life guard is on duty

Camp Good News t-shirts are available for purchase

What Campers Can Expect . . .

(Not all activities are held at every camp)

ARCHERY • ARTS AND CRAFTS

BANQUET • BASKETBALL

BIBLE LESSONS • CAMP CRAFT

CAMPFIRE • CHESS • CHAPEL

COUNTY FAIR • HAYRIDE • GREAT FOOD

FISHING • FUN TIME • HIKES

JEWELRY • KNITTING • MAKE FRIENDS

MISSIONS • MUSIC • NEEDLEPOINT

PUPPETS • QUIZ DOWN • RIFLERY

SEWING • SINGING • SPORTS

SURPRISES • SWIMMING

ULTIMATE FRISBEE • WILDERNESS COURSE

Who Children ages 6-12

When July 8-12 or July 15-19

Registration begins at 8:30 a.m. Monday morning. The week begins at 9:00 a.m. Monday and ends daily at 3:00 p.m. Campers are dismissed on Friday following the award program which begins at 2:00 p.m. Family and friends are invited to attend!

Where GOOD NEWS CLUB, INC. OF NORTHUMBERLAND COUNTY

CHILD EVANGELISM FELLOWSHIP

53 Blue Hill Northumberland, PA 17857

(Route 147 next to PPL)

How Much $60

A $30 non-refundable fee is required with a completed registration form per child. The remain-ing balance of $30 is due the FIRST DAY OF CAMP.

Shamokin Day Camp

When June 25-28

Visit the Shamokin Day Camp web page at gncnc.org/shamokindaycamp for location, pricing, and other information.

Day Camp Registrations limited to 60 per week

Preregistration recommended by June 5

Free camp t-shirt included with

overnight camp registration!

Choose from two weeks

of day camp in 2019!