Building a Generation for Jesus Christ, One Camper at a Time

Building a Generation for Jesus Christ, One Camper at a Time 

Camp Joy 2010

June 20-26th

Ages 7-14

Child’s Name ______Age ______Gender: M__ F__

Child’s Birth date______Names of Parents ______
Home Address ______City ______CA, Zip Code ______
Home Phone# (___)______Work # (___)______Cell # (____)______
Emergency Contact (other than parents): Name ______Relationship to child ______
City ______Home # (___)______Other # (____)______

______

Health Insurance and Health Information of the child:

Insurance Company ______Policy # ______

Is your childallergic to any types of medicine? Yes____ No____
If yes, please specify ______

Is your child allergic to any types of food or plants? Yes ____No____

If yes, please specify ______

Does your child have any type of disease? Yes ____No____
If yes, please specify ______

Does your childhave a restricted food diet? Yes ___ No____
If yes, please specify (you may attach a list to this application) ______

If your child gets a headache or a stomachache, what medicine should be given (Advil, Tylenol, etc.)
______

Did your childhave any type of surgery in the past year? Yes ____No ____
If yes, please specify what type and when? ______

Has your child broken any bones in the past? Yes ____No____
If yes, please specify ______mo/yr______
(Please attach any additional times of injuries with broken bones and surgeries if applicable).

Will your childbe able to play all sports and engage in physical activities at camp? Yes____No____
If no, please specify which physical activities are not allowed and attach a list to this application.

What else do we need to know about the health of your child? ______

______

I have given the correct information regarding my child’s personal information and health history.

Signature of Parent or Legal Guardian: ______Date: ______

Medical Consent Form

Evangelical Christian Church

I hereby authorize the participation of (child’s full name) ______in activities of the Evangelical Christian Church. In consideration of the Evangelical Christian Church providing these activities, I on behalf of myself and other parents and guardians of the minor, do hereby release the Evangelical Christian Church and its staff from all claims and causes of action by reason of any injury which may be sustained as a result of these church activities, whether on the church premises or on the way to or from these activities. I agree to direct my child to cooperate and to conform to directions and instructions of personnel of the organization in charge of these activities. Should my child not do so, and should those leading an activity believe it necessary, I will come and remove my child from the activity as soon as possible after being called by a staff representative for that purpose. I understand and agree to leadership having access to my child’s room at all times.

I hereby give my permission to the physician, nurse, or dentist selected by the Evangelical Christian Church to secure medical or dental aid as required for illness or injury under a physician’s orders, including transportation to and from the necessary facilities. As a participant, I understand

that the Evangelical Christian Church is not obligated to carry any insurance to cover those medical and/or dental expenses. I understand that my personal insurance is my primary coverage.

Signature of Parent or Legal Guardian: ______Date: ______

______

Regular Price:

$200per child!–If applications and checks areturned in or postmarkedby June 6th, 2010.

Special Discountsfor Bigger Families: Frist two children pay full price.* 3rd, 4th, 5th, and etc… go Free.*

*Late fee of $20 after June 6th still applies.

Late Applications:

$220 per child! - If applications and checks areturned in or postmarkedafterJune 6th, 2010

or on the first day of camp (June 20th, 2010)!

Make checks payable to Evangelical Christian Church & add Camp Joy 2010on the Memo Line.

Please send your child’s application and payment (checks only)to the Address:

Camp Joy 2010Attn: Nadia Shevchuk, Camp Director 116 W. Francis St., Corona, CA 92882

For more information: please call Nadia Shevchuk at (951)283-5379

or go to websites: and

Note:Children will be placed in groups according to their ages. We want all children to have an opportunity to make new friendships at Camp Joy. There will beno changes made regarding placements of children in their groups at the registration.Parents may make requests about special placement of no more than 3 children in one group and no later than June 10th!

We are looking forward to see your child at Camp Joy: June 20th – 26th, 2010