Midwest Camp Kogape 2019 Registration Form

Camp Registration

KOGAPE ($0.00)
High School and Middle School Summer Camp

2nd Child

Discount for 2nd Child Registration

Participation

Camper ($245.00)
Team leader ($200.00)
Core Staff ($170.00)

Running Total

$0.00

Participant's Information

Name

Address

Phone Number

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Date of Birth

Gender

Male
Female

Last Grade Finished

T-Shirt Size

Emergency Contact

Emergency Contact Name

Emergency Contact Phone Number

Relation to the participant

Code of Conduct

I will refrain from negative activity during this Camp. This includes such things as name-calling, putdowns, swears, excluding others etc. I will also respect other campers physically by not compromising their safety or hurting them. I will not bring or use any alcohol or drugs to camp.
I will respect God, others and myself by participating and being on time to all camp activities. Being on time will help me prepare my heart and keep the program running well; therefore I will be on time to all activities. Participation with a positive attitude is essential for a good camp experience. I also will commit to be on camp grounds at all the time, unless with specific permission from Camp directors.
I will respect God, others and myself by wearing appropriate clothing at all times. Clothing is a great way to express oneself, so let’s express ourselves in a God-honoring way. The preferred shirt is a T-shirt, bring lots of them. Clothing that is too tight or too short, bikinis or European-style swim trunks are considered inappropriate. Shorts must be at least finger length and NO “holy Jeans”!
I will respect the authority of all central figures, including parents, group leaders, lecturers, and the Camp Directors. Joy is created by unity centered on a higher purpose.
I will respect God’s Creation. The Camp Workshop facility is part of the Creation and should be treated well. I will leave the camp in a better state than I found it. I will keep the camp clean by putting all of my garbage in the appropriate place and picking up any garbage I see. I will keep my own belongings tidy.
I am coming to this Camp Workshop to experience God through the teachings, the friendships, and the creation! The use of cell phones, music players, laptops, game devices, and comic books while are not encouraged during the workshop, as this is an opportunity to experience God through the nature and others. Games can be played at home.
I understand that, if my conduct is found to be in violation of this code by the Workshop Staff, they will notify my parents and I will be removed from the camp at my or my parent’s expense (without reimbursement of the Registration Fee).
I will respect God, others and myself by observing “lights out”. The end of the day is as important as the beginning. I understand that everyone gets the most out of camp on the foundation of a good night’s sleep.
I hereby authorize the staff of the Camp, into whose care said minor has been entrusted, to consent to any emergency medical treatment or hospital care to be rendered to said minor under the supervision and upon the advice of a physician or surgeon licensed under the provisions of the Medical Practice Act or by a dentist licensed under the provisions of the Dental Practice Act. I further authorize the staff of the Camp to have said minor released into their custody should hospital care no longer be required.

Medical Form

Allergies to food or medication (type NONE or list all that apply)

Health problems - asthma, heart condition, seizures, diabetes, sickle cell, etc. (type NONE or list all that apply

Clinic or Regular Doctor Name

Clinic or Regular Doctor Address

Clinic or Regular Doctor Phone

Insurance Plan

Membership Number

Parent / Legal Guardian Consent

By my signature below, I attest to the fact that all the information above is true and that I have given approval for the Camp Workshop Staff to provide emergency medical treatment or hospital care for my child ONLY ihttps://manage.webconnex.com/f I cannot be reached or am unable to be contacted.

Parent / Legal Guardian Name

Total

$0.00

Billing Information

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Name

Payment Method

Credit Card
Cash or Check

Credit CardSecure Payment

Address

Phone Number

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