Midwest Winter KOGAPE 2021 Registration Form

Registration Fee Calculation

What type of participant are you?

Camper ($120)
Team leader ($80)
Core Staff ($60)
Kitchen Staff

Are you an additional sibling registering?

Yes (-$40)
No

Are you eligible for the Early Bird registration? (deadline 11:59pm 12/10/2021)

Yes (-$30)
No

Running Total

$0.00

Participant's Information

Name

Date of Birth

Gender

Male
Female

Current school year

Church Community Name

Home Address

Home Address

Phone Number

Yes, it's okay to send me text messages including confirmations, changes, and updates. Message frequency varies. Message and data rates may apply. Reply STOP to cancel. View our terms of service & privacy policy.

Are you in need of a bed with a mattress? (sleeping on the floor causes back pain, poor sleep, etc.)

Do you NOT mind sleeping on the floor with a sleeping bag?

Emergency Contact

Emergency Contact Name

Emergency Contact Phone Number

Relation to the participant

Accept Code of Conduct

I will respect the authority of all central figures, including the Core Staff, other workshop staff, speakers, and parents. Joy is created through unity centered on a higher purpose.
I will respect the workshop’s facilities and God’s creation. 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 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. Participation with a positive attitude is essential for a good camp experience. I will also commit to be on workshop grounds at all times, unless with specific permission from Core Staff.
I will respect others, God, 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 am coming to this workshop to inherit from God through education, peer and elder relationships, and His creation. The use of cell phones, music players, laptops, gaming devices, and comic books are strongly discouraged during the workshop.
I will refrain from negative activity during this workshop. 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 wearing appropriate clothing at all times. Clothing is a great way to express oneself, so let’s express ourselves in a God-honoring way. Clothing that is too tight or too short is considered inappropriate. Shorts must be at least finger length and no “holy jeans”.
I understand that if my conduct is found to be in violation of this code by the Core 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 hereby authorize the workshop staff, 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 workshop staff to have said minor released into their custody should hospital care no longer be required.

Please read and accept all.

Medical Form

Food or Medication Allergies (type NONE or list all that apply)

Other Serious Health Concerns - ex. asthma, heart condition, seizures, diabetes, sickle cell, etc. (type NONE or list all that apply)

Insurance Plan

Membership Number

Clinic or Regular Doctor Name

Clinic or Regular Doctor Phone

Clinic or Regular Doctor Address

Clinic or Regular Doctor Address

Parent / Legal Guardian Consent

With 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 if I cannot be reached or am unable to be contacted.

Parent / Legal Guardian Name

Total

$0.00

Billing Information

Confirm Email

Name

Payment Method

Credit Card
Cash or Check

Credit Card

Visa
Mastercard
American Express
Discover

Address

Phone Number