CAMPER APPLICATION FOR 2007
River Of Life Bible Camp
P.O. Box 726
Howland, Maine 04448-0726
Phone: (207) 732-4492
www.rolbc.org
|
Office Use Only:
Date Received:__________________________
Paid:__________________________________
Balance:_______________________________
Cabin:_____ Counselor:___________________
|
|
Camper's
Name:_________________________________________________________________________
Camper's
Address:_______________________________________________________________________
Town or City:______________________________________
State:________________ Zip:_____________
Parent's
Name:__________________________________________________________________________
E-mail
Address:__________________________________________________________________________
Sex M:______ F:______ Home Phone:______________________ Work
Phone:_______________________
School Grade:( as of September )_________ Date of
Birth:_____/_____/_____ Age:_________
Church
attending:________________________________________________________________________
Church
address:_________________________________________________________________________
PLEASE CHECK ONE:
| |
|
| ____ Junior Camp 1, (Ages 8-12) July 09-13 |
____ Teen Camp, (Ages 13-16) July 30 - Aug. 3 |
| ____ Junior Camp 2, (Ages 8-12) July 16-20 |
____ Teen Camp, (Ages 13-16) Aug. 6-10
|
| ____ Day Camp, (Ages 4-7) July 23-27 |
____ Teen Retreat, (TBA)
|
CAMP FEES:
Junior & Teen Camps $90.00 per week
Day Camp $40.00 per week
Teen Retreat $15.00 two days
Maximum Fee per Family per week $250.00
The camp capacity is 50 campers per week. Registration and a $20.00
deposit should be in as soon as possible to get the desired week.
Please make checks payable to River of Life Bible Camp
HEALTH RECORDS
HAS THE CAMPER HAD :
| Appendicitis_____ |
Polio_____ |
Scarlet Fever_____ |
Bed Wetting_____ |
| Mumps_____ |
Hernia_____ |
Whooping Cough_____ |
Allergies_____ |
| Pneumonia_____ |
Chicken Pox_____ |
Measles_____ |
Hay Fever_____ |
| Appendectomy_____ |
Athlete's Foot_____ |
Epilepsy_____ |
Ear Trouble_____ |
| Polio Immunization_____ |
Tonsilitis_____ |
|
|
Date of last Tetanus shot__________________________
Are all other immunizations up to date?_____________
Environmental Allergies:_______________________________________
Reaction:______________
Drug Allergies:_______________________________________________
Reaction:______________
Food Allergies:_______________________________________________
Reaction:______________
Medications presently taking: (prescriptions, over-the-counter,
vitamins, creams, ointments):
|
DRUG NAME(S)
|
DOSAGE
|
REASON TAKING
|
HOURS TAKING
|
| 1. ________________________ |
________________ |
________________________ |
________________ |
| 2. ________________________ |
________________ |
________________________ |
________________ |
| 3. ________________________ |
________________ |
________________________ |
________________ |
| 4. ________________________ |
________________ |
________________________ |
________________ |
All medication should be in original bottle with camper/staff
member name, medication name, and current dosage written on it.
Can your child take Tylenol should the need arise? Yes No
Signed:____________________________
Diet Restrictions (if
any):__________________________________________________________________
Activity Restrictions (if
any):______________________________________________________________
**Female Only:
Has this person menstrated?_______ If not, has she been told about
it?________ If so, is her menstrual
history normal?_______ Special needs:____________________________ May
she use tampons?________
WHAT TO BRING
Campers should
bring casual clothes and sportswear. Shorts and tops should be
loose-fitting and modest. One-piece bathing suits are required.
Bring a Bible, notebook with pen or pencil, pillow and sleeping
bag or bedding, and toiletry items.
The camp operates a snack shop in
which campers can purchase extra snacks throughout the week. Any money
for the snack shop should be paid at registration. A refund of any
unused funds will be issued on Friday evening before departure.
DO NOT bring Walkmans, CD/MP3
players, Gameboys, matches, or lighters. Alcohol, non-prescription
drugs, tobacco products are absolutely prohibited, as well as any types
of knives, firearms, or explosives.
Registration is at 1:00 PM on
Mondays. Campers need to be picked up Friday evening at 8:00 PM.
Parents are encouraged to attend our closing ceremony at 6:30 PM.
REGISTRATION TIME is at 1:00 PM Monday.
Campers need to be PICKED UP ON FRIDAY EVENING at 8:00 PM.
Parents are encouraged to attend our closing ceremony at 6:30
PM.
Parental Authorization:
This information is correct to the best of my knowledge and the person
herein described has permission to engage in all camp
activities except as noted by me and/or an examining physician. I give
my permission for routine medical treatment to be
administered by the Camp medical personnel to the above named
camper/staff member.
In the event I cannot be contacted, I hereby
give permission to the physicians selected by the Camp director to
order
x-rays, routine tests, and treatment for the health of my child.
In the event I cannot be contacted in an emergency,
I hereby give permission to the physicians selected to hospitalize,
secure proper treatment for, and to order injection and/or anesthesia
and/or surgery for my child as named above.
Signature:___________________________________________________
Date:____________________
(Parent, Guardian, or self (must be 18 yrs. old)
Witness:____________________________________________________
Date:____________________
(If not signed in the presence of the Camp medical personnel)
Initial Medical Exam
Notes:________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Medical Examiner's
Signature:___________________________________________
Date:______________
Enter any comments, questions, and other information that you would
like us to have below.
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
To The River Of Life Bible Camp