to help Camp Hawkins prepare the grounds and facility for summer camp

Shadowbrookmission tr ip

Camp Hawkins is a summer residential camp for youth, ages 8-21, coping with varying developmental disabilities such as Cerebral Palsy, Down Syndrome, Attention Deficit Disorder, Au-tism, learning disorders, brain inuries and other developental delays.

Camp Hawkins, Mt. Airy, GASaturday, March 7, 2015

8:00am – 4:00pmAll volunteers must be 8 years and older to participate.

Summer Campfor Children with Developmental Disabilities

Preparing for

Shadowbrookmission tr ip

Saturday, March 7, 20158:00am – 4:00pm

Camp Hawkins800 Rudeseal Rd.

Mt. Airy, GA

The purpose of this trip is to help Camp Hawkins prepare the grounds and facility for summer camp.

Camp Hawkins is part of the Georgia Baptist Children’s Homes and Family Ministries, Inc.

Camp Hawkins is a summer residential camp for youth, ages 8-21, coping with varying developmental disabilities such as Cerebral Palsy, Down Syndrome, Attention Deficit Disorders Autism, learning disorders, brain injuries and other develop-mental delays. Go to www. gbcfm.org and click on the “Developmental Disabilities Ministries” tab for more information about Camp Hawkins.

TRIP FACTSVolunteers All volunteers must be 8 years and older to participate. Children 14 years and younger must be

accompanied by a parent or guardian.

Travel You can drive your vehicle, carpool, or catch a ride on one of the church vans. The vans will leave Shadowbrook at 8:00am and return to Shadowbrook by 4:00pm.

Cost There is no cost for volunteers.

Food Shadowbrook will provide lunch and bottled water. Feel free to bring other drinks and snacks.

Project Volunteers will be involved in construction, landscaping/grounds keeping, general clean up and other tasks.

Supplies/Tools Work gloves, gardening tools, rubber gloves and cleaning rags. More information about supplies/tools will be coming in the near future.

Weather If the trip has to be canceled due to bad weather, Alex Croxton will send out a cancellation notice through email by 7:30am on the morning of the trip.

Deadline Registration deadline is March 1, 2015.

Registration & Questions

Registration forms are included in this packet. Registration forms are also available on the Shadowbrook Baptist Church website at www.shadowbrookchurch.org. If you would like to go on this mission trip, please fill out one registration form per person and turn them in to Alex Croxton or Wendy Kuntz at the church office. Email questions to Alex Croxton, croxtona@yahoo.com or Wendy Kuntz, wkuntz@shadowbrookchurch.org.

Location Camp Hawkins, 800 Rudeseal Rd., Mt. Airy, GA 30563

Directions from Suwanee

Head toward Lawrenceville Suwanee Rd NW (GA-317) on Buford Hwy NW (US-23 N)Turn right onto Buford Dr NE - Go for 1.4 miles Turn left and take ramp onto Atlanta Gainesville Hwy (I-985 N) toward Gainesville - Go for 28.2 milesContinue on Cornelia Hwy (US-23 N) - Go for 18.0 milesTurn left onto Hazel Creek Rd - Go for 0.1 milesTurn right onto Rudeseal Rd - Go for 0.8 milesYour destination on Rudeseal Rd is on the right.

Distance: 52.61 miles

REGISTRATION & INSURANCE FORM FOR ADULTS

• The information below will be used only in case medical attention is needed for you.

• You may still participate without insurance.

Please print when filling out this form. One form per person.

NAME OF ACTIVITY _______________________________________________ DATE _______________________________

shadowbrookB A P T I S T C H U R C H

INSURANCE INFORMATION

NAME OF INSURANCE COMPANY _______________________________________________________________________

ADDRESS _______________________________________________________________________________________________

PHONE ________________________________________________________________________________________________

POLICY # __________________________________________ GROUP # __________________________________________

CARD HOLDER’S NAME ____________________________________________ DATE OF BIRTH ______________________

EMPLOYER OF PRIMARY CARD HOLDER ___________________________________________________________________

PLEASE ATTACH A COPY OF YOUR INSURANCE CARD (FRONT & BACK) TO THIS COMPLETED FORM

DO YOU HAVE MEDICAL INSURANCE? o Yes o No If yes, please complete the following:

MEDICAL INFORMATION

ALLERGIES _____________________________________________________________________________________________

DIAGNOSED CONDITIONS (PHYSICAL & EMOTIONAL) _____________________________________________________

CURRENT MEDICATIONS ________________________________________________________________________________

________________________________________________________________________________________________________

IF ADDITIONAL SPACE IS NEEDED PLEASE USE THE BACK OF THIS FORM

BY MY SIGNATURE BELOW, I GIVE SHADOWBROOK BAPTIST CHURCH AND THE PERSON IN CHARGE PERMISSION TO SEEK MEDICAL ATTENTION FOR ME IF I AM UNABLE TO COMMUNICATE TO MEDICAL PERSONNEL.

SIGNATURE _____________________________________________________ DATE ________________________________

NAME _________________________________________________________________________________________________

BIRTHDATE (month/day/year) _______________________________________ PHONE _______________________________

ADDRESS ______________________________________________________________________________________________

EMAIL _________________________________________________________________________________________________

EMERGENCY CONTACT NAME ___________________________________ PHONE _______________________________

DOCTOR _____________________________________________________ PHONE _______________________________

STUDENT/CHILD REGISTRATION & INSURANCE FORM

• The information below will be used only in case medical attention is needed for your student/child.

• Your student/child may still participate without insurance.

Please print when filling out this form. One form per person.

NAME OF ACTIVITY _____________________________________________________ DATE _________________________

I GIVE MY PERMISSION FROM MY STUDENT/CHILD TO ATTEND THE ACTIVITY LISTED ABOVE.

PARENT/GUARDIAN SIGNATURE _________________________________________ DATE _________________________

EMAIL _________________________________________________________________________________________________

EMERGENCY CONTACT NAME ___________________________________ PHONE _______________________________

shadowbrookB A P T I S T C H U R C H

INSURANCE INFORMATION

NAME OF INSURANCE COMPANY _______________________________________________________________________

ADDRESS _______________________________________________________________________________________________

PHONE ________________________________________________________________________________________________

POLICY # ________________________________________________ GROUP # ____________________________________

CARD HOLDER’S NAME ___________________________________________ DATE OF BIRTH ______________________

EMPLOYER OF PRIMARY CARD HOLDER ___________________________________________________________________PLEASE ATTACH A COPY OF YOUR STUDENT/CHILD’S INSURANCE CARD (FRONT & BACK) TO THIS COMPLETED FORM

DO YOU HAVE MEDICAL INSURANCE FOR YOUR STUDENT/CHILD? o Yes o No If yes, please complete the following:

MEDICAL INFORMATION

ALLERGIES _____________________________________________________________________________________________

DIAGNOSED CONDITIONS (PHYSICAL & EMOTIONAL) _____________________________________________________

CURRENT MEDICATIONS ________________________________________________________________________________IF ADDITIONAL SPACE IS NEEDED PLEASE USE THE BACK OF THIS FORM

STUDENT/CHILD’S NAME _______________________________________________________________________________

BIRTHDATE (month/day/year) _______________________________________ PHONE _______________________________

ADDRESS ______________________________________________________________________________________________

STUDENT/CHILD’S DOCTOR ____________________________________ PHONE _______________________________

BY MY SIGNATURE BELOW, I GIVE SHADOWBROOK BAPTIST CHURCH AND THE PERSON IN CHARGE PERMISSION TO SEEK MEDICAL ATTENTION FOR MY STUDENT/CHILD IF I AM UNABLE TO BE REACHED.

NAME OF PARENT/GUARDIAN (print) ______________________________________________________________________

SIGNATURE OF PARENT/GUARDIAN ________________________________________ PHONE _______________________

DATE SIGNED ___________________________________________________________ PHONE _______________________

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