ne youth camp registration
DESCRIPTION
Camp RegistrationTRANSCRIPT
Registration fee: Jr. High Camp $20 High School Camp $30
2012 Northeast Region Summer Youth Camp
Camper Info:
Check one:
_____High School Camp ________Jr. High Camp
Name ______________________________ Sex_______________
Address___________________________________ Zip__________
City__________________________________ state______________
Age____________ Grade________________ Phone (______)___________________
Local church Youth Coordinator Signature___________________________________
Pastor, Lay Missioner, or Lay Speaker Signature______________________________
Contact Info:
Emergency Contact Name __________________________________________
Relationship___________________________Phone(______)________________
Any Other Instructions_______________________________________________
Medical History___________________________________________________
Has or is subject to:(check if yes)
_____Asthma ______Fainting Spells _______Convulsions
_____Diabetes ______Allergies _______Heart Problems
_________________Reaction to medication if yes list____________________
Please list any allergies__________________________________
Has difficulty with (Check if yes)
______Eyes/ears/nose/throat _________digestion ________Menstruation
___________Lungs
Any Condition require regular medication? ____________________________________
Name of medication_________________________Dosage____________________
Any restrictions of activity for medical reasons?_______________________________
___________________________________________________________________
Insurance Company ______________________________________________
Policy________________________________________________________
Insurance Company Address_____________________________________________
Insurer's Name________________________SS#__________________________
Youth SS#_________________________DOB__________________________
Doctor’s Name___________________Phone____________________________
I hereby certify that the above information is correct and complete to the best of my
knowledge, and the person herein described has permission to engage in all prescribed
activities, except as noted above. The adult supervisors of____________________may authorize any and all medical treatment without liability.
_________________________________________ ___________________
Parent/Guardian Signature Date
I,_________________________________agree to abide by the rules of conduct as
determined by the Northeast Region Youth Ministries and the staff of the Northeast
Region Youth Camp.
I, the parent(s)/guardian of, _____________________do hereby consent that she/he will
follow all the rules and regulations as determined by the camp. I will not hold the
Oklahoma Indian Missionary Conference, local churches, or any individuals responsible
for any injuries or accidents that occur on the campgrounds, travel to and from the
campgrounds, or during any activities outside of the campgrounds.
Signature of the Participant____________________________________________
Signature of Parent/Guardian__________________________________________
Oklahoma Indian Missionary Conference
Guidelines for Conference Related Events
I Covenant to.....
1. Put God first in my actions, thoughts, and decisions.2. Set aside time each day to reflect and pray.3. refrain from using chemicals of any type including tobacco. i will not have
fireworks, firearms, knives, or any destructive weapons.4. Be where I am scheduled to be at appropriate times. 5. Participate, with enthusiasm, in all activities planned, as I know I am an example
for others and am representing God, my Family, My church and my conference.6. Refrain from using inappropriate language while on this event.7. Have a great week; be an encourager and take great ideas back home to share.8. Always use a “buddy system.” travel in groups of 3, at least.9. Do not leave designated areas without proper adult permission.10. I agree not to bring any electronic devices, such as radios, Cd's, games, Ipods,
cell phones, etc.11.No alcoholic beverages, drugs, firearms, fireworks, guns, knives, or tobacco.12.All medication should be turned into the designated medical person.13.Any participant who does not adhere to the covenant and/or guidelines will be
sent home at parent’s expense.14.Participants who drive to camp must relinquish keys to the dean until the
completion of the event.15. I understand that there will be no late or walk-in registration once the deadline
has been set.16.Participant and parent/guardian must sign registration.17.OIMC is not responsible for any thefts.
______________________________________________ _______________
Participant Signature Date
______________________________________________ _______________
Parent/Guardian Signature Date