2018 Youth Camps

The Remnant Church of Jesus Christ of Latter Day Saints

Blackgum Campgrounds, Oklahoma * Cost $150

Registration, Health Form, and $50 deposit are requested by March 31, 2018

 Jr. High: For youth entering grades 6th through 9th for the 2018-2019 school year, approx. ages 11-14.

 Sr. High: For youth entering grades 9th through 12th for the 2018-2019 school year 2018 High School Graduates, approx. ages 14-18.

**Please note that campers entering the 9th grade may attend BOTH camps**

Each camp begins at 3 p.m. and ends at 11 a.m. on its respective Saturdays. Please do not arrive before the starting time and have your child picked-up before the ending time. A health check with the camp nurse will be required before a camper is allowed to stay.

For questions email or call (816) 721-9020.

***Please send the following to camp: appropriate and MODEST clothing, twin sheets & blanket or sleeping bag, scriptures, MODEST swimwear, towels & toiletries***

Fill out and return with Health Questionnaire & deposit to:

Remnant Church of Jesus Christ of Latter Day Saints Headquarters, Attn: Camp Registration

700 W. Lexington, Independence, MO 64050

Camper’s Name

Adult T-shirt size for the camper: X-small Small Medium Large X-large XX-large XXX-large

Is the camper a Remnant Church Member? Y or NLocal Congregation

In case parents or guardian cannot be contacted, please supply the following information as emergency contacts:

Friend/Relative ______Phone ( )______

Family Doctor ______Phone ( )______

We, the undersigned parents/guardians consent for our above named child to represent the Church in any and all activities. We also give consent for our child to be transported to said activity and will not hold The Remnant Church of Jesus Christ of Latter Day Saints responsible in case of accident or injury while enroute to or from said activity. We hereby agree to hold the Church, its employees, agents, representatives, leaders and volunteers harmless from any and all liability, action, Causes of actions, debts, claims or demands of every and any kind and nature whatsoever which may arise by or in connection with participation by my child/ward in any activities related to the activity checked above. If we cannot be reached and in the event of emergency, we also give our consent for the Church, sponsors, or leaders to obtain through a physician or hospital or its choice, such medical care as is reasonably necessary for the welfare of the individual if he/she is injured in the course of the activity of The Remnant Church of Jesus Christ of Latter Day Saints checked above.

Parent/Legal Guardian ______

Date______

2018 HEALTH FORM

The following information is needed for each camp/retreat/activity.

Name:______Birth date:______Age:_____

Address:______City:______State:____ Zip:______

Child Lives With : Mother  Father  Both parents  Other______

Guardian #1______Relation:______

Phone: (___)______

Guardian #2______Relation:______

Phone:(___)______

Guardian #3______Relation:______

Phone: (___)______

ALLERGIES:

(Example: Penicillin, Sulfa, Latex, Peanut Butter, Bee Stings, etc.)

 Food______

 Medicine______

 Other______

**List Child’s Medications**

Please send child’s medications in original pharmacy-issued bottles for the Camp Nurse

Medical History

 ADD/ADHD/Behavior Problems

 Asthma

 Diabetes

 Fainting

 Ear Problems

 Heart Murmur

 High Blood Pressure

 Sleep Trouble

 Seizures

 Urinary Problems

 Previous Concussion

Surgeries______

Date of last tetanus shot______Immunizations Current  Yes  No

Permission for camp nurse to provide over-the-counter medications:

 Tylenol  Ibuprofen  Benadryl  Claritin/Zyrtec  Tums  Acid Reducer  Hydrocortisone Cream

 Calamine Lotion  Sunscreen  Eye Drops  Cough Medicine  Cough Drops  Neosporin Ointment

 Decongestant Female Campers:  Tampon (may the nurse provide instruction if needed?)

Release/Authorization

In case of emergency, I, ______(parent/guardian) authorize the care and treatment for______(child) that is deemed necessary by authorized medical personnel.

Parent/Guardian Signature______

Printed Name______Date______

Health Insurance Co:______

Policy #______Group#______

Parent/Guardian who carries the insurance______