NLOM Day Camp 2016 - Reservation Request
27416 Ranch Road • Ashland, NE • 68003-3518
Toll free: 1-888-656-6254 • www.nlom.org
PLEASE TYPE OR PRINT
Congregation ______Church Phone ______
Church Address ______City/State/Zip Code ______
Church e-mail ______Web Site ______Pastor(s) ______
Staff working with this program Position ______E-mail______
Please let NLOM know if this information changes.
Day Camp Coordinator E-mail
Address City/State/Zip Code
Daytime phone ______Home phone ______Cell Phone
On-Site Day Camp Coordinator E-mail
Address City/State/Zip Code
Daytime phone ______Home phone ______Cell Phone
2016 Day Camp Options
Week 1 ……………… June 6-10 Week 6 ……………… July 11-15
Week 2 ……………… June 13-17 Week 7 ……………… July 18-22
Week 3 ……………… June 20-24 Week 8 ……………… July 25-28 (short week)
Week 4 ……………… June 27-July 1
First Choice ______Second Choice ______Do you anticipate more than 60 campers? ______
Day Camp Program Cost
· Base fee = $1950 (covers cuppies, program supplies and staffing)
o Add an additional $30 per camper over 24 campers (maximum of 80 campers total)
· Short session = $1700 (covers cuppies, program supplies and staffing)
o Add an additional $25 per camper over 24 campers (max of 80)
· Non-refundable, non-transferable deposit of $300.00 due with reservation form
· Non-refundable, non-transferable deposit of $300.00 due on April 1, 2016
· Balance due last day of scheduled Day Camp week
Reservations are accepted on a first-come-first-serve basis. A $300 non-refundable, non-transferable deposit must accompany the signed registration form. Checks should be made out and sent to NLOM. Credit cards are not accepted for Day Camp payments. Keep the pink copy for your congregation’s records. Please send the yellow copy to NLOM.
I have read, understand and accept the conditions of this contract as outlined on the back of this contract, including the billing schedule and the responsibilities of the congregation regarding the required training, volunteer needs, camper capacity and coordinator responsibilities.
Printed Name ______Signature ______Date ______
Office Use Only:
NLOM - POLICIES AND PRACTICES GOVERNING DAY CAMP
COORDINATORS The church is expected to recruit a Day Camp Church Liaison, who serves as a liaison between the church, campers, families and NLOM. It is their job to ensure the congregation fulfills their responsibilities related to day camp, including securing the needed volunteers and host homes for NLOM staff. The On-Site Day Camp Church Liaison must be at least 21 years of age, and MUST be on site each and every day for the entire week. They are expected to meet daily with the NLOM Day Camp team to review plans and discuss any concerns. The congregation provides a secure campsite with storm shelter, phone, restrooms and water.
NEW DAY CAMP The training materials will be available online or sent to you upon request. If you are a new Day
CONGREGATIONS Camp congregation, please call Kelsey Ellis or Korey Breutzmann at 402-944-2544, and we will gladly set up a time to meet with you to go over all of the materials and answer questions.
SUPPORT Volunteers will be needed to assist with snacks, camper registration, promotion and other
VOLUNTEERS administrative duties. Support volunteers include snack volunteers, lunch volunteers, registration assistants and host families for the NLOM staff members.
PROGRAM The congregation is expected to provide one program volunteer for each 8 campers at all times VOLUNTEERS during the day camp week. At least 50% of the program volunteers must be 16 years of age or
older. A volunteer training session is planned for Sunday night prior to the start of your Day
Camp week.
SCREENING The congregation must take the necessary steps to safeguard and protect the campers. VOLUNTEERS This includes screening and training all volunteers. The process of screening is not meant to scare
off the volunteer but to ensure volunteers are aware of their responsibilities and understand job
expectations and to be sure we provide a safe environment for campers. The congregation is
ultimately accountable for volunteers.
PROGRAM Day Camp 2016 is for children who will complete 1st – 6th grade during the 2015-
BASICS 2016 school year. Kindergarten children stretch the staff and the program beyond our limits. They just require additional support and a different level of programming for the program to be truly effective. Congregations are welcome to set their own age limits for Day Camp but NLOM will serve only children in grades 1-6 this summer.
Camper capacity is set at an absolute maximum of 80 campers/site.
FORMS & FEES Day Camp program fees for campers are determined by the congregation. The congregation is responsible for camper recruitment, registration, collecting fees and securing a health history for each program participant including adult volunteers. All NLOM programs require pre-registrations. Walk in registrations will be negotiated in advance with the NLOM Day Camp Coordinator.
BILLING Payments will be made in three increments. To hold your reservation we require a $300 non-refundable, non-transferable deposit due with your signed reservation contract. A second non-refundable, non-transferable payment of $300 is due by April 1, 2016. The balance is due the last day of your day camp session. Checks should be made out to NLOM. Credit cards are not accepted.
Yellow Copy: to NLOM Pink Copy: Church Copy