Costs and Deadlines

COSTS AND DEADLINES

$170-Pre-registration
postmark deadline June 10

$180-Registration
postmark deadline June 24

$190 - Late registration
postmark deadline July 8

$200-At-the-door registration

$50 non-refundable deposit by due date secures rate with balance due upon check-in on first day of camp.

All campers must complete registration and activities release forms. Paintball release form is required only for those intending to play paintball. Cost includes meals, housing, recreation and all program materials. Campers are encouraged to bring money for snacks during the week at the Snack Shack and/or money for Paintball games ($10/per).

ADULT SPONSORS

Each church is responsible for providing at least one adult sponsor/counselor (or ratio of 1:8) to assist during the week and share in the discipleship process. A background check will be conducted for all adults at the camp. There are no registration fees for adult sponsors.

Info & Applications -

ARRIVAL AND DEPARTURE

ARRIVALS: Check-in begins at 3 p.m. on the first day of camp. There will not be staff on the campground before 3 p.m. available to supervise the campers.

DEPARTURE: Friday 12noon.

Late arrival or early departure requires approval from the CampDirectorand proper check-out at camp.

Mail completed form and deposit/registration fee to:

JUSTIN PICKARD

825 N. COCKRELL HILL RD.

DESOTO, TX 75115

MAKE CHECKS PAYABLE TO:DALLAS NYI

WHAT TO BRING

A BIBLE

Lots of clothes for fun

Swimsuit (one-piece for girls)

A cover-up for pool

Sleeping bag or twin bedding

Flashlight Pillow

Personal hygiene items

Snack/Paintball money

WHAT NOT TO BRING

Fireworks Guns & Weapons Knives

CD Players Video Games

Shaving Cream (except for personal use)

CELL PHONES/TEXT DEVICES

This year we are encouraging campers to bring cell phones as they will have the opportunity to use them throughout the week to send/receive messages to/from the camp director, chapel speaker, and other campers during specified services and program elements. Regular texting fees will apply. Parents, please evaluate your cell phone/text plan prior to camp and discuss with your camper any limits, concerns, etc. Counselors & staff are not responsible for lost, stolen, or broken cell phones.

CAMPRULES

1.A minimum $50 fine will be assessed for vandalism, graffiti or defacement of camp property.

2.Proper respect of the camp facilities, rules, other campers, and staff will be expected of all campers.

3.Appropriate attire that emphasizes modesty will be worn at all times.

4.Swimmers must be covered to and from the pool.

5.Possession of illegal drugs, firearms, alcohol or tobacco will result in suspension from the camp.

6.The camp is closed to all but registered applicants.

7.Drivers 18 and under must turn in vehicle keys at registration for the duration of camp due to liability concerns.

MEDICAL INFORMATION

A registered paramedic/nurse will be on duty at all times. However, the camp insurance is a supplemental insurance to personal insurance.

All medications must be turned in at registration.

TO WRITE TO YOUR CAMPER, MAIL EARLY TO:

SCOTTSVILLE NAZARENE CAMP

POST OFFICE BOX 307

SCOTTSVILLE, TX 75688

Check out for more info

TEEN CAMP (July15-19, 2013)– Scottsville

REGISTRATION & MEDICAL FORM

NAME______BIRTHDATE ______GENDER (circle) M F______GRADE AS OF 5/12

ADDRESS______CITY______STATE______ZIP______

DESIRED ROOMMATE ______T-SHIRT SIZE S M L XL

***IMPORTANT NOTE: Cell phones are not required, however teens will have the opportunity to use cell phone features throughout camp to send/receive messages to/from the camp director, chapel speaker, and other campers during specified services and activities. Regular texting fees will apply. Parents, please evaluate your cell phone/text plan prior to camp and discuss with your camper any limits, concerns, etc. For more info see “Cell Phone” content on the Camp Info Sheet or visit Counselors staff are not responsible for lost, stolen, or broken cell phones.

***PARENT INITIAL - ______- I have read the above statement and talked with my teen about it.

***CAMPER INITIAL- ______- I have read the above statement and talked with my parent(s) about it.

***CAMPER CELL#______CELL CO.______CAMPER EMAIL______

***By initially and filling in cell phone info you are giving permission for your teen to use their phone as described above.

PARENT(S) ______PARENT EMAIL______PARENT CELL PHONE ______PARENT OTHER PHONE ______

OTHER CONTACT ______RELATIONSHIP ______PHONE______

NAME OF CHURCH______CITY______

PASTOR’S NAME______FEE ENCLOSED?(circle one) YES NO

************************************************************************************************************************************

MEDICAL HISTORY

FAMILY DOCTOR______PHONE NUMBER______

INSURANCE COMPANY______ADDRESS______

INSURED’S NAME______EMPLOYED BY______

POLICY #______ID#______INS. COMPANY PHONE #______

DATE OF LAST TETANUS BOOSTER______ALLERGIES TO MEDICATION, FOOD, PLANTS, INSECTS? list: ______

PLEASE CIRCLE ALL THAT APPLY: Appendix removed fainting spells heart problems seizures asthma diabetes chicken pox tuberculosis HIV positive developmentally disabled prosthetics other:

MEDICATIONS (Do not send sample packs of medications. Must be in a pharmacy-filled prescription package).

Medication: ______dose______frequency______reason______

Please list additional medication on the back. All medication must be given to camp nurse upon check-in.

SPECIAL NEEDS (Diet, Rest, Exercise, Nutrition):______

______

SPECIFIC MEDICAL DIAGNOSIS:______

______

AUTHORIZATION FOR MEDICAL AND SURGICAL CARE:

This is also a release to authorize certified personnel of the Dallas District Camp Coordinating Board to call an authorized doctor and to administer medical aid and treatment for my child at any time when they believe an emergency exists. This would include all treatment such as emergency or prescription medication, minor or major surgery, hypodermic injection (including tetanus booster), and the like. In the event of any surgical procedures or major injury, parents will be contacted by phone.

______

PARENT DATE WITNESS

Campers must also have Participation & Activities Release of Liability Form signed

(see reverse or next page)

ScottsvilleCamp & ConferenceCenter

400 Harkins Lane ◈ P.O. Box 307 ◈ Scottsville ◈ Texas ◈ 75688 ◈ (903)938-5847

PARTICIPATION & ACTIVITIES

WAIVER AND RELEASE OF LIABILITY

READ CAREFULLY

In consideration of SCCC furnishing services and/or equipment to enable me to participate in activities, including but not limited to: Swimming, Biking, Paintball, Canoeing, Paddle Boating, Archery, Skating, Basketball, Volleyball, Football, Baseball, Bonfires, Fishing, Low Ropes Course, Hot Air Ballooning, Slip and Slide, Tug-of-War, I agree as follows:

I fully understand and acknowledge that; (1) risks and dangers exist in my use of equipment and my participation in activities; (2) my participation in such activities and/or use of such equipment may result in my injury or illness including but not limited to bodily injury, disease, strains, fractures, partial and/or total paralysis, eye injury, blindness, heat stroke, heart attack, death or other ailments that could cause serious disability; (3) these risks and dangers may be caused by the negligence of the owners, employees, officers or agents of SCCC; the negligence of the participants, the negligence of others, accidents, breaches of contract, the forces of nature or other causes. These risks and dangers may arise from foreseeable or unforeseeable causes; and (4) by my participation in these activities and/or use of equipment, I hereby assume all risks and dangers and all responsibility for any losses and/or damages, whether caused in whole or in part by the negligence or other conduct of the owners, agents, officers, employees of SCCC, or by any other person.

I, on behalf of myself, my personal representatives and my heirs, hereby voluntarily agree to release, waive, discharge, hold harmless, defend and indemnify SCCC and it’s owners, agents, officers and employees from any and all claims, actions or losses for bodily injury, property damage, wrongful death, loss of services or otherwise which may arise out of my use of equipment or my participation in activities, I specifically understand that I am releasing, discharging and waiving any claims or actions that I may have presently or in the future for the negligent acts or other conduct by the owners, agents, officers or employees of SCCC. This waiver is good until May 1, 2014.

I HAVE READ THE ABOVE WAIVER AND RELEASE. BY SIGNING THIS WAIVER AND RELEASE, I AGREE IT IS MY INTENTION TO EXEMPT AND RELIEVE SCCC FROM LIABILITY FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH CAUSED BY NEGLIGENCE OR ANY OTHER CAUSE.

______

Participant’s NameParticipant’s Age

______

Participant’s AddressParticipant’s Date of Birth

______

Participant’s City, State and Zip CodeParticipant’s Phone Number

______

Participant’s E-mail AddressParent/Guardian Phone Number

______

Excluded Activities

______

*Signature of Parent/GuardianSignature of Participant

*Required if Participant is under 18 years of age

Campers must also have Teen Camp Registration Form completed

(see reverse or other page)

TEEN CAMP - PAINTBALL RELEASE FORM

(form is required only for those intending to play paintball)

Paintball is an optional activity at camp. All safety and other equipment will be supplied.

Campers must purchase paint on-site ($10 cash). Official paintball refs will be on-site during all games.