Kids Camp
KMAK 2017
Completed:
3rd - 5th Grade
June 19-22, 2017
@Tulakogee Conference Center
KMAK:
KMAK (Kids Mission Adventure Kamp) is especially designed for 3rd – 5th grade kids to
have the time of their lives while growing closer to Jesus and the other kids attending
camp. Kids will enjoy non-stop fun, which includes Tulakogee’s 160 foot, 3-turn water
slide and pool, climbing wall, mini golf, pedal carts, mountain bikes, fishing, canoeing,
archery, basketball, flag football, Nerf wars, and more. Even better than the activities is
the high energy kids-style worship and Bible Study that will be experienced each day. To
sum it up, KMAK IS AWESOME!!!
Camp Pricing:
1 kid attending
2 kids attending:
3 or more kids attending:
$190.00 per student
$180.00 per student
$170.00 per student
Price Includes: KMAK T-Shirt, $10.00 Snack Bar Card, Tulakogee KMAK Backpack, all
meals, 3 nights lodging, all crafts and activities, church group picture, and transportation.
Scholarships
Please do not let cost be a factor in your decision to go. We have a limited number of
scholarships that we offer on a case-by-case basis. Scholarships are not always
guaranteed and we are unable exceed $100.00 when approved.
Request a scholarship packet from the Family Ministry Office.
Team Leader Information:
Boys: Noah Wickham
Girls: Lisa Lippert
(918)341-8181
(918) 857-8447
[email protected]
[email protected]
Parent and Camper Meeting:
Plan to attend the Camper and Parent Meeting on Sunday, June 11th at 7:00pm in the First
Kids Multi-Purpose Room
Complete This Packet Online or Return it in Hardcopy to the Family Ministry Office by
Sunday, June 11th.
Kids Mission Adventure Kamp
KMAK June 19-22, 2017
(T-shirt size Circle One)
Youth: Y-Med, Y-Large
Adult size: S M
L XL XXL
Cabin
First
________________________________________________
Registration Form 2017
Name of person attending camp:
School Grade Completed_
Sex (circle one) M F Age
Birth date
_
Sponsoring Church:
Parent or Guardian (of minor)
_Home Phone:
_
Address
City
St
Zip_
e-mail:
_
In case of emergency notify:
Relationship_
Emergency phone numbers: Day
Night_
Cell
_
Physician’s Name
(Imperative if your child has allergies.) Phone_ _________
List any allergies to medications or any known allergies
Date of last tetanus immunization
List medications presently being taken: __________
Medical Insurance Company
Insurance Policy #_
(The above information is needed in case your child or the sponsor has to be taken to the hospital and the
parent/guardian cannot be reached.)
Date
Signature of Parent /Guardian/Sponsor
AUTHORIZATION FOR EMERGENCY CARE TO A MINOR
I/we the undersigned, parent(s) or legal guardian of the minor (name)
(Birthday)
, do hereby authorize any X-ray examination, anesthetic, dental, medical, or
surgical diagnosis or treatment by any physician or dentist licensed by the State of Oklahoma and
hospital service that may be rendered to said minor under the general, specific or special consent of:
(Name of adult sponsor who is temporary custodian of minor)
It is understood that this consent is given in advance of any specific diagnosis or treatment being
required, but is given to encourage those persons who have temporary custody of the minor, and said
physician or dentist to exercise his/their best judgment as to the requirements of such diagnosis or
medical or dental or surgical treatment.
Date
Parent /Legal Guardian
Last
AUTHORIZATION FOR MEDICAL INFORMATION RELEASE
I hereby authorize the hospital to release the following information contained in its hospital records to the
representative of the Tulsa Metro Baptist Association concerning Diagnosis, prognosis for
Date of birth
Name of Camper/Sponsor
This information will be used for insurance billing.
Date
Signature of Parent or Guardian/Sponsor
Church
Kamper Name ________________________________________________
XXXL
Please make sure you have one (1) ORIGINAL FOR TULAKOGEE and one (1) copy
FOR THE CHURCH
KMAK
PARENTAL AUTHORIZATION TO
ADMINISTER MEDICATION
This medication form must accompany ALL medication to be given at KMAK. All medications MUST be given to the Camp First Aid
person at the time of arrival in the original container, whether it is a prescription or over the counter medication.
I hereby give my permission to the Camp First Aid person and to designated camp staff to administer medication to my child at
KMAK.
Name of Child
Age:
Church name:_
Weight:
City:_
I understand that the camp first aid person and/or the KMAK staff shall not be liable to the student, parent, or
Guardian of the child for civil damages for any personal injuries to the student, which result from acts or omissions
In administering any medication at KMAK.
Signature of Parent or Legal Guardian
Date
Name of medication(s): _____________________
MEDICATION MUST BE BROUGHT IN THE ORIGINAL CONTAINER
______________________________________________________________________________
Reason for medication to be given and/or comments:
Time(s) to administer medication at camp:
Dates to administer medication at camp:
Side effects to be reported to parents:
Side effects requiring immediate medical attention:
List of medications:
2)
3)
4)
A.M. Breakfast
Monday
Tuesday
Wednesday
Thursday
Notes from first aid person: _
Noon Lunch
P.M. Dinner
Bed Time
Serious Life Threatening Policy
Policy: Tulakogee Conference Center
Tulakogee (KMAK) is prepared to administer first-aid for their campers. It is EXTREMELY
important that the camp administration be made AWARE of ANY situation that requires medical
attention beyond first-aid:
Examples of but NOT exclusive are:
1.
2.
3.
4.
5.
6.
7.
8.
Leukemia – Cancer (under Rx)
Diabetic Types I & II
Severe Asthmatics (requiring emergency on person inhalers or nebulizers)
Chemotherapy
Heart condition
Organ transplant recipient or on list
Growth hormones
Severe allergies to insects, food, etc. requiring epi-pen or other extreme meds
Tulakogee administration will evaluate each situation individually in determining what measures
need to be taken to ensure the camper’s safety and wellbeing during their stay.
Please complete this form and return to your church/organization administration prior to
registering for camp.
Organization
Date
Camp date
Campers name
Age
Condition:
Who will be accompanying camper (signature/relation to camper): (spouse, parent, guardian)
X
This is accurate info (signature): X
PERMISSION RELEASE FORM
PARTICIPANT/PARENT/GUARDIAN WAIVER AND INDEMNITY AGREEMENT
Claremore First Baptist Church
107 E. Will Rogers Blvd.
Claremore, OK 74017
CIRCLE ONE:
CHILD / YOUTH / ADULT
This is to verify that
has my
permission to attend the First Baptist Church activities. This form is good from January
1st through December 31st , 2017.
In consideration of your accepting me or my child for participation in the activities
of the above mentioned group, I hereby, for myself, my heirs, executors, and
administrators, waive and release any and all rights and claims for damages that I may
have against the above-named organization.
I warrant that I have the right to authorize the foregoing and do hereby agree to
hold the above-named organization harmless of and from any and all liability of
whatever nature which may arise out of or result from such participation.
For the consideration stated above, I further agree that in the event that my child
or I should make any claim against the above-named organization for damages arising
out of the activities, I will personally indemnify, defend, and hold harmless the
organization and its agents, employees, representatives, successors and assigns
against any and all loss and damage occasioned thereby, including attorney's fees.
I have read and understood this Agreement and have willingly placed my
signature below as evidence of my acceptance of all the conditions contained herein.
I also grant my permission for my son/daughter to receive medical treatment
deemed necessary by a licensed physician.
Insurance Company
Policy#
Insurance Phone #
Contact Within
Signature: Participant
hours
Date
(If participant is not a minor)
Parent/Guardian:
Date
(Must Sign in Presence of Notary)
SIGNATURE OF:
Witnessed By:
Notary Public
Date
Commission Expires:
Commission #:
ROGERS COUNTY
STATE OF OKLAHOMA
Claremore First Kids Camp
To Bring or Not to Bring
What to Bring:
 Bible, pencil and pen for notes
 Comb or brush
 Bedding: Sleeping bag or sheets (Twin size) or blanket, pillow
 Toiletries: Soap, shampoo, toothbrush, tooth paste, towels.
 Clothes for five days
 Walking shoes (tennis shoes)
 Swimsuit for the pool and water slide (Modest tankinis and one pieces are
welcome)
 Sunscreen & bug spray
 Flashlight
 Laundry bag for wet and dirty clothes (can be a trash bag)
 Sweater or light rain jacket
 Umbrella
 A respectful attitude that is ready to grow in Christ and have a ton-o-fun.
What Not To Bring
 Electronics: cell phone, video games, mp3 players
 Shaving cream
 Silly String
 Water balloons
 Water guns
 Bikinis
 Revealing clothing
 More than $10.00 extra spending money.
 A disrespectful attitude that hinders spiritual growth and fun of others