TRAVELING DAY CAMP 2016  “COURAGEOUS FAITH”
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                                                                                                9:00a.m. to 5:00p.m.
                                                                                                               *Early drop-off will be available, if needed

                                                                              at New Horizons United Methodist Church

                                  at 1020 El Chaparral 1 mile east of HWY 63 exit on Broadway/WW across from Casey’s

This is an AWESOME week-long experience for children who have completed kindergarten through 6th grade.  Children will participate in a Christ-centered time with opportunities to grow within the unique fun and outdoor setting of this week!  We will have activities galore, water games like slip ‘n slide, crafts, singing, and Bible lessons. 

                  There is NO COST for the week.  Register SOON, space is limited!.  Lunch & snacks will be provided.

New Horizons UMC has partnered with Heartland Camps, Parkville MO, to provide this terrific day camp and bring their enthusiastic trained young adult counselors and all the activities!! 

The strength of the Traveling Day Camp is the people!  The teams are comprised of young college adults who are selected for their work ethic, Christian commitment, and their love of children.  The Heartland staff is trained to lead the worship and Bible study and all the wild and zany recreation.  Our congregation will also be assisting the teams. 

                      HOW TO REGISTER

                                    Register NOW ON-LINE – Registration Form located on this page

                                         OR Register at New Horizons’ Office:

                                               6-8pm  Thursday June 23 thru Wednesday June 29

                                                    OR Call the Church Office:

                                                           to save a spot and receive a mailed registration form

                                                                (573)443-7058
 
                                      REGISTRATION FORM
 
 
 

Child's Name (required)

Gender (required)

Age (required)

Birth Date (required)

Grade Completed (required)

Parent or Guardian (required)

Email

Street Address (required)

City and State (required)

Zip Code (required)

Phone (required)

Secondary Phone (required)

Who will bring and pick up child (required)

Child permitted to arrive & leave at 5 by self? (required)

Will child need Early Bird arrival 7:30a.m. to 8:45a.m.?(required)

T Shirt Size (required)

Does child attend church regularly

Medical Consent: I affirm I am the parent/legal guardian of child authorized to execute medical consent form on behalf of the child. Enter your name. (required)

Emergency Contact #1 (required)

Phone (required)

Emergency Contact #2 (required)

Phone 2 (required)

Medical Professionals: doctor (required)

Medical Professionals phone (required)

Permission to contact? (required)

Insurance Provider (required)

Policy Holder (required)

Group# and ID# (required)

Permission to Contact (required)

Are immunizations current? If requested, be able to supply current records. (required)

Date of last Tetanus shot? (required)

Physical Health History: Does your child have or have they ever had any of the following? (required)

If yes & had lice, last date?

If you checked any of the above and feel like explaining would help us serve you child best, please do here.

Allergies: please list and indicate an anaphylactic reaction and when it occurred.

Does your child have an Epi-Pen (required)

Does your child have asthma? (required)

If yes, please write down the triggers and any information we would need to know to serve your child best.

Does your child have diabetes? (required)

If yes, please answer the following: blood sugar range

Date of last reaction?

Recurring Health Issues that we should be aware of?

Mental Health: Does your child have or have ever had any of the following? (required)

Mental Health: Does your child have or have ever had any of the following? (required)

If you checked any of the above and feel explaining would help us to serve your child best, please do so here:

Nutrition: please check any that apply to your child

Nutrition: other food concerns

Medications: Please list any medications and dosage of any medication your child will need to take during day camp.

Participation: Is your child in general good health and able to participate in all normal camp activities (required)

Consent: You certify that the above information is correct and give permission for the release of medical records in case of illness or accident. (required)

I have read activity risks & administration of over-the counter drugs and give permission. (required)

Permission for providing emergency treatment (required)

Agree my child or myself to have pictures taken by Heartland and New Horizons UMC for publicity. (required)

Behavior: My child agrees to follow all camp rules & expectations. (required)

I will arrange transportation home at any time if Camp Director requires due to illness or behavior.
(required)

Any additional information you would like to provide to help your child have an awesome week?

As the parent or guardian I understand that I am expected to read the information on the webpage concerning permissions being requested and agreed.

(required)

 

Parents and Guardians are expected to read the

information concerning permissions agreed upon.

In signing this application, I hereby certify that the above information is correct and give permission for the release of medical records in case of illness or accident.

In case of medical emergency, I understand that every effort will be made to contact a parent or guardian of the camper. In the event I cannot be reached, I hereby give permission to the physician selected by Heartland Center Director to hospitalize, secure proper treatment for, and to order injection, anesthesia, or surgery for the participant named above.
 
I give my child permission to participate in all camp activities including challenge course – both high ropes and low ropes appropriate to my child’s age as well as archery, if offered. I understand that Heartland trains their staff and inspects their equipment regularly to reduce risk. I understand there are still inherent risks with all camp activities. I release Heartland and all its employees from any liability related to my child’s participation in camp activities. Participating in the challenge course may involve bending, twisting, lifting, running, jumping, climbing, increased heart or breath rates and physical contact with others. Unexpected strains or jolts to your body can occur
 

I give permission for Heartland to administer the following over-the-counter drugs or their equivalent (in accordance with product labeling) to my son/daughter if deemed necessary by the Heartland Center Health Care Manager: Tylenol, Pepto-Bismol, Maalox. Ibuprofen, Claritin, Benadryl, Cough/Throat Spray, Eye Drops/Visine, and Swimmer’s Ear Drops, Calamine Lotion, Ivy Dry.

 
I agree to allow my child (or myself) to have his/her picture taken and those pictures to be used in Heartland Center and New Horizons United Methodist Church publicity. My child agrees to follow all camp rules & expectations and I will arrange transportation home at any time for my child if camp director requires it due to behavior or illness.