What to bring: Games Bible Class Challenge Crafts Drama

--twin sheets, pillow, blanket for bunk beds

--towels, wash cloths, soap
--comb, shampoo, deodorant
What to wear: Be comfortable & appropriate
--toothbrush, toothpaste
Girls: jeans, pants, skirt, capris, shirts
--sunscreen, hat NO tank top or halter top!
--swimsuit with a t-shirt (shirts must cover your waist)
Shorts must touch your knees.
--large towel or cover-up
Boys: jeans, pants, shirts, shorts
--clothes for day and evening
NO tank top! (must cover your waist)
--Jacket or sweatshirt Shorts must touch your knee.
--money for snacks Pants must be pulled up at all times.

--Bible, if you have one NO alcohol NO tobacco NO drugs

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Campers Name: ________________________________________________________________________________________________________________________ Date of Birth ______________________

Health Info: Please Answer All. No child will be admitted without a completed and signed form.

List medicine allergy: _____________________________________________________________________

List food or any allergy: __________________________________________________________________

Insurance Co. _____________________________________ Ins Phone Number (___ )____ -________

Insureds Name___________________________________ Policy _________________________________

Did he/she have all vaccines (shots)? ________ Date of recent Tetanus shot? ____/___/____

Any reason not to play sports? _________________________________________________________________

Does your child have any of these? Please mark with the dates and Explain on paper
ADHD____ Allergies _____ Epi-pen: YES NO Asthma _____ Inhaler: YES NO Diabetes ______
Eating disorder?________________ Ear (tubes, cochlear implants, aids, etc)_________________________
Eye/Visual (glasses, contacts, etc)_____ Fainting ____ Seizures____ Kidney/Bladder or bedwetting _____
Trouble Sleeping? _________________ Other________________________________________________
Recent surgery or health issues: _____________________________________________________________
Is there any information that the nurse should have to best take care of this camper (restrictions on activities,
mental or emotional issues, etc..)?____________________________________________________________
_____________________________________________________________________________________
Name of Medication Dosage & Time To Give Other Instructions

? Yes or No (please circle one) ? May the nurse give over-the-counter, non-prescription meds or
applications; for stomach discomfort, burns, cuts, insect bites, rash, aches, fever, cough, etc.
*If camper needs medication, send it to camp in the original bottles with instructions for the Nurse.
>Please put medicine in a ziploc bag and write his/her name on the bag.
>Give all medicines to the adult reponsible for your childs ride to camp.

____________________________________________________ __________
Signature of Parent/Guardian date