Policies for Pastoral Adult Campers
Greetings,
We are very excited that the children from your church will be attending CampPiankatank and that you will be joining us as well! We welcome you to an experiment. You are part of a kind of pilot program inviting adult youth workers to attend camp with the campers from their church. We see the many benefits of having you attend with the campers. We know you can help them take the many learning experiences they have back home with them.
The adults from your church will be required to pay the same fees as a camper. You are eating meals and taking a bed, and participating in the program so you will pay the same fees.
Here are the guidelines we have put in place as to who may attend camp with their campers.
- Church groups with more than 5 attending from their church may send adult campers with their children to camp. This is for children attending as a group sponsored by a church, not for children simply attending independently with a few friends.
- Though we recognize that a parent may attend as the adult from their church. Parents attending should agree to give their children independence, which is one of the greatest learning opportunities in a camp experience.
- Churches may send only one female and one male representative for every 15 males and 15 female campers. Cabin groups have 16 beds. We want to keep as many beds open to children and teenage campers, as this is our main target audience.
- Adults should be physically able to walk long distances. No smoking is allowed at all.
- Adults should be willing to sleep in a bunk bed in a room with the children of the same gender attending with your church group. Nights are late and mornings are early, so be ready.
As this is a pilot program we want to make a few things clear to you up front about your role during the week so we can all be on the same page for an awesome experience for all. We are protective of our campers and our program, which parents appreciate. You will probably have campers in your group and in your cabin who are not a part of your church, so we need to keep our rules consistently followed with everyone.
- You arenot considered a chaperone. We provide all the supervisory staff that is needed for a full camp experience. We have many independent campers and even many church campers who do not attend with adults. We consider you a special camper, an adult simply participating with your kids. Our staff will be instructors and supervisors of the campers. Your role is to enjoy camp with your campers. Learn along with them, help them pay attention to their leaders, help them have meaningful experiences they can take home with them. Especially if you are a parent of a camper let them have independence.
- Follow the rules too. Kids look up to adults as leaders no matter who you are. Please support the rules that are in place here. Here are some you need to be aware of and that you will be held to as well:
- No medications in cabins. All over the counter and prescription medications must be turned in to the camp upon arrival. If an emergency occurs we need to know what you have taken and when. We keep meticulous medical records. Also, we need to prevent campers from finding medications and taking them; which could be very bad if they are allergic or for other possibly sinister reasons. The exception to this is inhalers, emergency insulin for diabetics, and epi-pens, but even for these exceptions please document these needs on your medical form so that we will be aware of your needs.
- You may not distribute medications. This is a liability that we will take on. The camp’s policy is that all medications be turned in to the camp upon arrival and we will monitor their distribution. Parents should not expect you to distribute them. This does apply to over the counter medications as well.
- No cell phones. We have this rule to encourage camper and parent independence. Also, we need to know what is going on. If a child is missing home talking to a parent is not the best first step to helping them learn to be away from home. If parents need to be contacted we pride ourselves in keeping them up to date. We will call them if we need them. It’s only 6 days. You may keep your cell phone in your car and YOU may use it on break times away from camper sight. PLEAE do not allow a camper to call home with your cell phone without the camp’s permission under any circumstance.
- Don’t bring- there are other things campers are not allowed to bring to camp that will apply to you also. These items include- computers, ipods or other mp3 players, radios, candy, sodas, food of any kind, weapons, cigarettes (we have a strict no smoking policy), and obviously no drugs or alcohol. We also encourage you not to bring cash (you can check your snack money into a trading post account) or anything valuable. Bring clothes that you won’t mind getting dirty.
- Be obedient as a good example.Campers need to obey the adults here, which means you need to set a good example and do the same. You can help our leaders by encouraging campers to obey also.
- Never be alone with a camper. This policy is in place to protect you. This is something you need to take very seriously. There have been cases in this country of children accusing adults of misconduct while alone with them and there are no other witnesses, so the adult is charged with child abuse (which is in many cases a felony) based on the simple claims of the child. Our staff follow this policy, we call it the Camp Golden Rule “Never be alone with a camper, and never leave a camper alone”. Please always be with at least two campers or better yet at least two adults. Also, never leave a camper alone. This applies even to children you already know because it is a camp policy.
- At least go to the activities. As a rule campers are not allowed to stay behind when their group goes to an activity. This means we ask you to do the same. While you are there you may choose to participate or not. The best attitude to have would be to go and support your campers and participate with them. You are here to experience camp with the campers, so go out and have fun.
- Children reflect adult’s attitudes. Please have a good attitude of support for the camp and our staff. Even small comments or your non-verbal communication can turn a child’s attitude as well. Be excited and energetic about what is going on and the kids will get excited too. Even the worst situation can be fun if you make it fun and have a good attitude.
- Your Concerns. Please talk to the staff about your concerns. Like we said, we like to know what is going on. If you have concerns let us solve them together instead of gossiping or having a rotten attitude. In some cases concerns may be discussed with the camp counselor. If this is the case please do so respectfully, in private, away from the campers. Other cases may need to be directed to the CampDirector, and Steve or Niki would be happy to help you.
- Physical Endurance. Our program was designed for kids. And well, probably none of us have energy of a 12 year old any more. We want you to be expecting lots of physical exercise while you’re here and heat. Expect to walk long distances several times a day. If you participate at activities they may involve anything from climbing, running, or swimming. It would behoove you before you come to camp to start a little physical exercise to get your body ready. If you have physical limitations that may hinder you from walking long distances you may need to consider that this may not be the best program for you to attend. Talk to us about your concerns.
- Forms. There are a few attached forms for you to fill out. Those details are attached as well. We require you to fill out a health history form as well so that in case of an emergency we will have the information we need to help you.
We’re going to have a great time! Please join us in praying for the camp and our campers in the weeks and months before camp. We want children and youth to come to know the Lord better while they are here. Some may come to know the Lord for the first time during their time here. We want our campers to have a safe and fun experience and we want you to also. Please let us know how we can help you prepare yourself and the children for their time here.
Blessings,
Steve and Niki Gourley
Co-Directors, CampPiankatank
CampPiankatank is owned and operated by the Virginia Baptist Mission Board.
Checklist for Pastoral-Adult Campers
_____ Proof of Criminal Records Background Check- You must provide proof of a criminal records background check from within the last year. If such proof is not available we will run the check on you for $10. This form is attached. As you are an adult staying with children we need to assure that you do not have a record of certain crimes that could be of concern to parents. Please mail this to the address below at least 3 weeks before your camp dates.
Mail to: The Virginia Baptist Mission Board
Attn: Anita Caudill
2828 Emerywood Parkway
Richmond, VA23294
_____Health Form- Yes, we need a health form from you too. This is in case of emergencies and so that we can serve your needs better. Bring this with you to camp.
_____This Form- We only allow church leaders to attend with the children from their church. Please have the pastor of your church sign the approval for you to attend. Mail to: CampPiankatank
P.O. Box 435
Hartfield, VA23071
_____ Are you registered? You must register yourself just like a camper and pay the fees a camper pays. Put your cabin buddies as the names of the children you wish to bunk with. Just put yourself as your parent. If you need to check your registrations call the camp office at 804-776-9552.
Church Approval
I, ______a leader at ______(church name) approve ______(attendee’s name) to attend CampPiankatank with the children involved with our church’s ministries. I believe he/she will be of benefit to the campers attending and will support the ministry at CampPiankatank and its purposes.
______(pastor’s signature)
Participant’s Agreement
I, ______(attendee’s name) have read the document “Policies for Pastoral-Adult Campers” and agree to follow and support Camp Piankatank and it’s staff while I’m here, including following all rules. I have taken into consideration all the policies in place and can abide by them.
______(attendee’s signature)
Piankatank Adult Camper
CRIMINAL RECORDS CHECK AUTHORIZATION
(PART A)
I hereby give my permission for the Virginia Baptist Mission Board to obtain information relating to my criminal history record. The criminal history record, as received from the reporting agencies, may include arrest and conviction data as well as plea bargains and deferred adjudications. I understand that this information will be used, in part, to determine my eligibility for an employment or volunteer position with Virginia Baptist Mission Board.
I also understand that as long as I remain an employee or volunteer here, the criminal history records check may be repeated at any time. I understand that I will have the opportunity to review the criminal history and a procedure is available for clarification, if I dispute the record as received. I also understand that, by law, I may see a copy of the transcript, for its review, but may not receive a copy of the document in any fashion or form.
I, the undersigned, do for myself, my heirs, executors and administrators, hereby remise, release and forever discharge and agree to indemnify the Virginia Baptist Mission Board and each of their officers, directors, employees, and agents harmless from and against any and all causes of actions, suits, liabilities, costs, debts, and sums of money, claims, demands, whatsoever, and any and all related attorney’s fees, court costs, and other expenses resulting from the investigation of my background in connection with my application to become a volunteer or employee of Virginia Baptist Mission Board.
Please initial in the box if you would like to grant permission to the VBMB to perform a back ground check for the next 5 years without having to complete this form each year. The check will only be done if you are asked to participate on a project with the VBMB.
Print Name ______Date ______
Applicant’s Signature ______
Print Witness Name ______Date ______
Witnesses’ Signature ______
PLEASE COMPLETE PART A AND B
CRIMINAL RECORDS CHECK
(PART B)
Full Name ______
Last First Middle Maiden
Physical Address ______
______
How long have you been at this address? ______
If less than one year, please give previous address ______
______
Sex: (please indicate)Male ______Female ______
Date of Birth:______/ __ __ / __ __
Year Month Day
Social Security # ______- ______- ______
(helpful in correctly identifying volunteer applicants)
Have you ever been convicted of a crime? _____yes _____no
Are there any legal charges pending against you? _____yes _____no
If yes, please explain: ______
______
______
The signature represents my current legal name and any previously used names are listed below:
Additional names: ______
______
______
Signature of ApplicantDate
PLEASE COMPLETE PART A AND B
CAMPPIANKATANK
Health History and Examination Form
Directions:
1)This form is required for camp attendance and must be updated yearly.
2)This form includes 5 pages. You must turn in all pages.
3)There are two mandatory signatures on this form, marked by a double asterisk (**), this includes the permission to provide treatment statement, and the parent/guardian authorization; additionally if information from a doctor’s physical is not available the medical waiver on page 5 must be signed.
4)To help us out immensely please staple or paper clip these forms in numerical order when they are turned in
5)DO NOT MAIL ANY PART OF THESE FORMS TO THE CAMP BEFORE ARRIVAL. PLEASE BRING THEM WHEN YOU ARRIVE FOR CAMP. This is not a registration form. This is the health form for those already registered.
CAMPER INFORMATION
CampAttending______Dates______
Camper Name______Birthdate______
First Middle Last
Home Address______
City State Zip
Gender ___ Male ___ Female
Age at camp______Camper’s Weight ______Camper’s Height ______
EMERGENCY CONTACT
Name______Home Phone ______
Cell Phone______
Work Phone______
Relationship to camper______
Home Address______
City State Zip
PERMISSION TO PROVIDE TREATMENT
I hereby give permission to the camp to provide routine health care, administer prescribed medications, and seek emergency medical treatment including ordering x-rays or routine tests. I agree to the release of any records necessary for treatment, referral, billing, or insurance purposes. I give permission to the camp to arrange necessary related transportation for me/my child. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the camp to secure and administer treatment, including hospitalization, for the person named above. This completed form may be photocopied for trips out of camp.
Signature Required for camp attendance.
______Date______
INSURANCE INFORMATION
Is the camper covered by family medical/hospital insurance? ___Yes ___ No
If so, Indicate carrier or plan name______Group # ______
CarrierAddress______
Name of Insured______
Relationship to camper______
Social Security number of policy holder or insurance ID number______
ALLERGIES
No known allergies.
List all known. Describe reaction and management of the reaction
Medication Allergies
______
Food Allergies
______
______
______
Other Allergies: Include Insect stings, hay fever, asthma, animal dander, etc.
______
______
______
MEDICATIONS
This person takes no prescribed or over the counter medications.
Please list ALL medications that should be taken at Camp, including over the counter medications.
Medicine # 1______Dosage______
Times taken each day______
At what time of the day is this medication taken ______
Reason for taking______
Medicine # 2______Dosage______
Times taken each day______
At what time of the day is this medication taken ______
Reason for taking______
Attach additional pages for more medications
RESTRICTIONS
The following restrictions apply:
Dietary______
______
Activity______
______
HEALTH HISTORY
Write N for No and Y for Yes then explain any “Yes” answers in the space provided below.
1. Had any recent injury, illness or infectious disease?...... ___2. Have a chronic or recurring illness/condition?...... ___
3. Ever been hospitalized?...... ___
4. Ever had surgery?...... ___
5. Have frequent headaches?...... ___
6. Ever had a head injury?...... ___
7. Ever been knocked unconscious?...... ___
8. Wear glasses, contacts or protective eye wear?...... ___
9. Ever had frequent ear infections?...... ___
10. Ever passed out during exercise?...... ___
11. Ever been dizzy during or after exercise?...... ___
12. Ever had seizures?...... ___
13. Ever had chest pain during exercise?...___
14. Ever had high blood pressure?...... ___
15. Ever been diagnosed with a heart murmur?...... ___
16. Ever had back problems?...... ___ / 17. Ever had problems with joints?...... ___
18. Have an orthodontic appliance being brought to camp?...... ___
19. Have any skin problems ?...... ___
20. Have diabetes?...... ___
21. Have asthma?...... ___
22. Had mononucleosis in the past 12 months?...... ___
23. Had problems with diarrhea/constipation?...... ___
24. Have problems with sleep walking?...... ___
25. If female, have an abnormal menstrual
history?...... ___
26. Have a history of bed-wetting?...... ___
27. Ever had an eating disorder?...... ___
28. Ever had emotional difficulties for which
professional help was sought?...... ___
29. Had H1N1, professionally diagnosed?...…..___
Please explain any “yes” answers, noting the number of the questions