2024 RMRCOG Summer Camp

Save & Return

Use an account to return to saved work.

There are 2 camps:
Senior Camp is for Students entering 6th grade through 12th grade June 21-23
Junior Camp is for students entering 2nd grade through 6th grade June 23-25
Note: Students entering the 6th grade may choose either camp but may only attend one or the other. *

My student is interested in attending Senior Camp June 21-23

My student is interested in attending Junior Camp June 23-25

First Name *

Last Name *

Male or Female

Grade Entering in the Fall *

Shirt Size Please Express Youth or Men Sizes *

Camper Email Address if applicable

Camper Phone Number

Street Address *

City *

State *

Zip Code *

Parent First Name *

Parent Last Name *

Parent Cell Number *

Parent Email Address *

Street Address *

City *

State *

Zip Code *

Emergency Contact other than parent First Name *

Last Name *

Phone Number *

Is there a friend you'd like to be in a room with? This may not always be possible, however we will do our best.

Church Name *

Group Leader *

Group Leader Email *

Student Insurance Carrier *

Insurance Carrier Phone Number *

Insurance Policy number *

Physician Name *

Physician Number *

Date of last Tetanus Shot *

Dental Insurance

Dental Insurance Policy number

Dentist Name

Dentist Number

Brief Health History: Asthma/Stomach or digestion/Epilepsy or seizures/Heart/Diabetes/Physical or Mental health concerns *

Medical History If necessary, describe in detail the nature and severity of any physical and/or psychological ailment, illness, propensity, weakness, limitation, handicap, disability, or condition to which your child is subject and of which the staff should be aware, and what, if any action of protection is required on account thereof. Submit this notification in writing and attach it to this form. Include names of medications and dosages that must be taken. *

Please list acceptable over-the-counter medications Adult Chaperones or medical personnel may administer, if necessary, without parent consent: Examples Tylenol, Motrin, Imodium, Pepto-Bismol, Benadryl, etc. *

All Applicants must complete the following:
I recognize that I am responsible for my behavior. I am dedicating myself to the lofty goal of preparing myself for an intense, life-changing, encounter with God. I will conduct myself in a respectful, mature, and courteous manner. I will adhere to all rules and policies and I will honor those who are over me in the Lord. I will do everything in my power to ensure that this RMRCOG Summer Camp 2023 is a spiritual success.

I, the student, have read the rules of conduct, and the health and safety limitations previously stated. I agree to abide by the personal limitations previously stated as well as the code of conduct while participating in all activities.

Activities may include, but are not limited to: cookouts, boating, swimming, basketball, roller skating, games in the park, soccer, broomball, ice skating, volleyball, softball, baseball, camping, skiing, snowboarding, sledding, hiking, biking, horseback riding, service projects, mission trips, scavenger hunts, concerts, Bible studies, miniature golf, hayrides, hide & go seek, water balloon fights, capture the flag, bowling. (Transportation to/from activities may be included as part of that activity).

Note: If you desire to limit your child’s participation in any event (including transportation), please submit your wishes in writing to the church youth pastor prior to that event.

clear

Date: *

For Campers aged 17 & Under, Signature of parent or guardian required below:
Parent Signature: By signing I/We agree the student has applicant has my permission to attend and be transported to and from all youth group activities sponsored by RMRCOG for the 2023 calendar year.

This consent form gives permission to seek whatever medical attention is deemed necessary, and release the Church and its staff of any liability against personal losses of named child. I/We the undersigned have legal custody of the student named above, a minor, and have given our consent for him/her to attend events being organized by the Church. I/We understand that there are inherent risks involved in any ministry or athletic event, and I/we hereby release the Church, its pastors, employees, agents, and volunteer workers all liability for any injury, loss, or damage to person or property that may occur during the course of my/our child’s involvement. In the event that he/she is injured and requires the attention of a doctor, I/we consent to any reasonable medical treatment as deemed necessary by a licensed physician. In the event treatment is required from a physician and/or hospital personnel designated by the Church, I/we agree to hold such person free and harmless of any claims, demands, or suits for damages arising from the giving of such consent. I/We also acknowledge that we will be ultimately responsible for the cost of any medical care should the cost of that medical care not be reimbursed by the health insurance provider. Further, I/we affirm that the health insurance information provided above is accurate at this date and will, to the best of my/our knowledge, still be in force for the student named above. I/we also agree to bring my/our child home at my/our own expense should they become ill or if deemed necessary by the student ministries staff member.

I understand that my child will be the responsibility of and supervised by the adult leader who brings them to RMRCOG Summer Camp 2023. I will not hold the Rocky Mountain Region Church of God Youth and Education Department liable for accident or injury. I understand that the Rocky Mountain Region Church of God insurance is secondary to the participants insurance coverage. Each church group assumes responsibility for their own medical release forms.
I understand that refunds will only be given if the event is cancelled due to inclement weather or acts of God.
Signature
*

clear

Date: *