the church of god --- family camp application for office use only date: rec’d notified deposit:...
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The Church of God --- Family Camp Application
For Office Use Only
Date:
Rec’d Notified
Deposit:
Rec’d Date
Check # Cash
Family Plan of
Cabin #
Cabin Leader:
Name:Date of
Birth:
Address:
Current Age: Male Female
Phone: Parent/Guardian:
Pastor’s Name: Local Church
Church Location:
How many in family attending camp (Including those serving on staff)?
Family Plan of
Church Member ____ How Long_____ Positions Held___________________________
Saved: Yes No Sanctified: Yes No Filled with the Holy Ghost: Yes No
City State Zip
City State Zip County
Rules for acceptance and participation in the program are the same for everyone without regard to race, color, or national origin.
I understand that when I sign this application below, I am agreeing to abide by all rulings and regulations of the camp. If I break any rules I understand that I am subject to disciplinary correction even to the expelling from camp.
The Camp Dress Code: To parents and Campers This is a Christian Camp, please dress accordingly. Boys long pants, girls hemline below the knee. To all church services, girls should wear dresses or skirts and boys should wear jeans or slacks. The following clothes are not acceptable: Shorts, Tank Tops, Sheer Fabrics, Skirts or Dresses above the knees. No jams, cutoffs, sleeveless tops. No bear stomach
or back showing. No T-Shirts with profane words and/or pictures. Please mark all personal items with camper’s name. Camping staff will NOT be responsible for clothing left on campground. Parent/Guardian will pick camper up as soon as possible after camp is dismissed.
If different from Parent/Guardian, who has permission to pick up camper? Name?
and
Please register by 11:30 AM Camp will end August 5 Please pick up your children, and those you bring to camp by 10:00 a.m.
Signature of Camper Signature of Parent/Guardian
FAMILY CAMP DATES: August 1 – August 5, 2011
CAMP TUITION: Campers: Ages 2 & Under FREE, Ages 3 – 5 $20 Ages 6 & UP $85.00 Staff: $75
LOCATION: Camp Maranotha 900 Old Mill Rd., High Point, NC 27265
STAFF BUILDING PHONE NUMBER: (336) 869-2251
NOTE: A deposit of $20.00 is required with this application. You may cancel up to one week in advance and receive a refund of deposit. All applications must be received by June 30, 2011 IF NOT THERE WILL BE A LATE FEE OF $10.00 ADDED TO THE TUITION****NO EXCEPTIONS****
Mail application to: The Church of GOD P.O. Box 1175 Hamlet, NC 28345
Camper’s Health Form ON REVERSE SIDE
MUST BE COMPLETE.
COST PER FAMILY OF
1 person $ 85.00 2 person $160.00 3 person $235.00 4 person $310.00 5 person $385.00 6 person $460.00
Parents Name
Parent/Guardian Information
This form must be filled out completely and signed in two places by a parent/guardian before the application can be accepted.
Name of Parent/Guardian
In Case of Emergency
Address Contact
Telephone Emergency Phone
Health History of Camper
Please give approximate dates, if you have suffered:
Rheumatic Fever Convulsion Fainting
Tuberculosis Sugar Diabetes Kidney Problems
Heart Trouble Sleep Walking Ivy or Oak Poison
Recent operations or illnesses
Allergic Reactions To: Bee Stings Penicillin Other Drugs
Details of above or additional information:
Any specific activities to be restricted?
Important: What is the date of your LAST tetanus shot?
Medical Insurance Company name? Subscriber name?
Policy # Group #
In case of Medical Emergency: I understand an effort will be made to contact the parent or guardian of the camper. In the event I cannot be reached I understand that if any accident should occur, I give permission to the physician selected by the Camp Director to hospitalize, secure proper treatment for and order injection, anesthesia or surgery for my child as named above.
Signature Date
I understand that if any accident should occur or any sickness which my child may have for which the Camp Insurance does not provide, the expense is my own responsibility and the camp will not be held liable for any expense in such case. (Travel insurance is provided by the camp for each camp activity for the duration of camp, plus travel time before and after camp, if the application is on file in the state office before camp starts.)
Signature Date
(Name of Adult to be telephoned)
Medications to be taken during your stay at the camp are to be given to the camp nurse.
Please list medication(s): Over The Counter (OTC)
Prescription Medicines (RX)
City State Zip
Baptismal Service
The normal routine for our Church Camp is if a child is saved during our services, or if they are saved before they get here and wished to be baptized again, they have the option to be baptized in a baptismal service held at the last night of our camp.
We understand that some parents may not wish for their child to participate in this part of our service. Please sign below in the appropriate box.
Again, thank you for allowing your children to be a part of our Family Camp.
Family Camp Director,
Sis. Brenda Odell
Baptismal Service Permission ____ Yes ___ No Signature:________________________
T - Shirts
The theme this year for camp is “The World Behind Me The Cross Before Me”We are planning to have T - Shirts this year but due to circumstances in the past years and we have lost money on the shirt orders, we will ONLY order what is pre-paid for. If you would like to order a T - Shirt, please check the appropriate size of the shirt and send in $10.00 for the T - Shirt. Again, if you do not send in your money for your shirt by June 30, 2011, then we will not be able to order a shirt. If you want one, please get your money in.
Child Small______ Med____ Large_____ Youth Small ______ Med_____ Large______Adult Small______ Med____ Large_____ X-Large_____ XX-Large______XXX-Large______
If you need additional sizing, please indicate here:_________________________
Visitors
All visitors MUST check-in at the office and fill out a application upon arrival so the Camp insurance can cover you if there is any type of accident or injury. If you come to camp on a daily basis the cost will be $5.00 per meal, overnight stay 1 day with meals is $25.00. Day visitors will have to leave the campground by 10:00 p.m.
Snack Shack
Snacks is NOT included in on the camp price for snacks in between recreation and classes. If you want your child to have
snacks, please send extra money for them to be able to purchase these items.
Cabin Assignments
If you have a friend at camp that you would like to be in the same cabin with, please list the name of the camper below. PLEASE NOTE: THE CAMPER MUST BE IN THE SAME AGE BRACKET AS YOU IN ORDER FOR THIS TO WORK….
Applicant Name:___________________________ Age:_______________
Campers Name (in which the applicant would like to share cabin with)______________________Age:____________
The Church of God North Carolina Family Camp
Prospective Staff Application
Section 1
Name Date of Birth
Address
Age Male Female Telephone
Married Single Divorced Widowed
Saved Sanctified Holy Ghost
Church Member how long? Which local church do you attend?
Name of Pastor
Note: To be considered for staff one should be saved, sanctified, filled with the Holy Ghost and a member of The Church of God
Section 2
For Office Use ONLY
Date:
Rec’d Notified
Deposit:
Rec’d Due
Check # Cash
Family Plan of
Bal. Paid By Church
Cabin # Staff Room
Cabin Leader:
In what capacity do you feel you are best suited? Teacher Counselor * Dean Recreation
Cook Night Watchman Concession Stand Program Director Music Director
Evangelist Camp Pianist Nurse RN or LPN
*With what age group do you feel best qualified to work?
Section 3
Do you hold any position as a church leader? Please give details
Are you willing to assume any responsibility you may be placed in?
Would you abide by the rules of the camp and tell campers to do the same?
Are you willing to forget yourself and put the needs of the camper first?
Are you physically fit enough for total participation in the camping program?
Can you be at camp on time and STAY UNTIL RELEASED from duties?
Do you participate in your local church activities consistently?
Will you attend Pre-Camp Training Session, if at all possible, for instruction on duties?
Singed Date
Section 4 Medical Information
Full Name
Health History: Check any that apply to you. Epilepsy Diabetes Convulsions Kidney Trouble
Asthma Heart Trouble Rheumatic Fever Sleep Walking
Serious Ivy, Oak or Sumac Poisoning Allergic to Bee/Wasp Stings
Allergic Reactions to Penicillin or other Drugs (List)
Please answer: Are you presently taking medications? If yes, list
Are you presently on a special Diet? If yes, please explain:
Date of last tetanus? Do you have hospital Insurance? Yes No If yes, give name of the Insurance Company
Name Policy #
Signature Date
When you have completed this application, give it to your pastor for evaluation and endorsement. There are many other applicants and we may not be able to use everyone.
Please remember you are at camp as a staff member, to e a blessing to campers and assist in their spiritual growth. Fellowship is a second blessing you will receive as a staff member but not the primary reason for working at camp.
Put God first, camper second, staff third, self last. Camp success depends upon staff members.
STAFF BUILDING PHONE NUMBER: (336) 869-2251
City State Zip
PASTOR’S ENDORSEMENTPASTOR: Please appraise this applicant prayerfully and honestly. It will give you the opportunity to talk with the applicant about his work in the local church. Please send your endorsement to the State Office within 5 days after you receive it.
Name of Applicant
Is Applicant Saved? Sanctified? Filled with the Holy Ghost
Is Applicant a church member in good standing? Yes No
If Applicant works, does he/she pay tithes? Yes No If no, explain
Please rate the following: Excellent Good Fair Poor
How is Applicant’s current spiritual condition?
Applicant’s attendance to all regular services including midweek?
Applicant’s dependability as a Christian year round?
How Applicant gets along and works with young people and children?
Applicant’s participation and cooperation in local church activities?
Applicant’s enthusiasm and genuine interest in camp?
Applicant’s Leadership ability in the Lord and the Church?
What position(s) of leadership does Applicant presently hold in your local church?
If none, please explain
Does Applicant boost and support the rulings of the General Assembly including the Advice to Members?
Yes No
What is the general attitude of Applicant? Explain
How is Applicant’s personal grooming, hygiene, dress, etc.?
Pastor, would you personally recommend Applicant as a Youth Camp Staff Member? Yes No
Comments and Suggestions
Have you discussed this evaluation with Applicant? Yes No
Pastor’s Signature Date
Please Mail To: The Church of God
P.O. Box 1175
Hamlet, NC 28345