MOVE
MOVE
TRI-STATE DISTRICT
Student Camp 2015
TRI-STATE DISTRICT
Student Camp 2015
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June 22-26, 2015 Cost: $245
CAMPER BASIC INFORMATION:
Last Name: _____________________ First Name:________________________
Address: _________________________________________________________
City: ________________________________ St:_______ Zip:_______________
Age:________ Gender: M/F (circle one) Last Grade Completed: ___________
Email: ___________________________________________________________
Local Church:_____________________________________________________
Parent/Guardian: __________________________________________________
Best Contact Phone: (_________)_____________________________________
11 For I know the plans I have for you,”
declares the Lord, “plans to prosper you
and not to harm you, plans to give you
hope and a future. 12 Then you will call on
me and come and pray to me, and I will
listen to you. 13 You will seek me and find
me when you seek me with all your heart.
Jeremiah 29:11-13
Alternate Phone: (________) ________________________________________
EMERGENCY CONTACT:
Name:____________________________________________________________
Relation to camper: ________________________________________________
This year’s theme, is about lining up with God’s purpose.
The premise is “God wants you to move with His purpose”.
Join us at Tri-State Student Camp this summer and learn
what you can do to MOVE!
Home Phone: (__________) _________________________________________
Work Phone: (__________) _________________________________________
Cell Phone: (__________) ___________________________________________
MEDICAL INSURANCE INFORMATION
Insurance Carrier:_________________________________________________
Policy Number: __________________________________________________
Phone: (___________) _____________________________________________
Address: ________________________________________________________
Name of Insured: _________________________________________________
Relationship: _______________________________
Please list any allergies, medications or activity restrictions: _____________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
TRI-STATE DISTRICT
Student Camp 2015
June 22-26, 2015 Cost: $245
Tri-State District
Student Camp 2015
June 22-26
IMPORTANT INFORMATION
MORE IMPORTANT INFORMATION
What to Bring
Price of $245 Includes:
Clothes for 5 days
Athletic shoes
Jacket
Toiletries (toothpaste, shampoo, deodorant, etc.)
Bedding (pillow, sleeping bag, sheets)
Towels (for swimming and showering)
Swim suit
Bible
Notebook & pen
Money for the snack bar and extra activities (Zip line,
horse back riding etc.)
• Sunscreen
• Camera (optional)
• Snacks (optional)
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What NOT to Bring
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Weapons of any sort
Alcohol or tobacco products
Fireworks
Bike, scooters, skate boards, etc.
Electronic gadgets (iPod, tablet, gaming systems, etc.)
Chainsaws
Extras:
Sky Ranch provides a variety of additional activities for
students during free time at an extra cost per activity.
Additional activities include:
• zip line
• paint ball or lazer tag
• skeet shooting
• horse back riding
TRI-STATE DISTRICT
Student Camp 2015
June 22-26, 2014 Cost: $245
Five day/four nights @ Sky Ranch Camp in Quapaw, OK
Meals while at camp (Dinner Monday - Breakfast Friday)
Water slides and lake access
All Tri-State Student Camp programming
Wednesday night “Messy Games.”
Camp T-shirt
MOVE
TRI-STATE DISTRICT
Student Camp 2015
June 22-26, 2015 Cost: $245
Medical Release & Camper Covenant
CAMPER COVENANT:
Key Dates:
• Pre-Registration deadline: May 15. (Please include $50 preregistration fee.)
• Camp check-in begins June 22 @ 3pm
• Camp ends June 26 @ 11am (There is no lunch served on the
26th.)
Directions from Miami, OK:
Exit off of I-44, go east on Hwy 10. Continue east on Hwy 10
approximately 6 miles and look for the Sky Ranch sign at the
corner of CR 650 and Hwy 10. Follow the signs approx. 4.5 miles
to the camp entrance. 7750 S 655 Rd, Quapaw, OK 74363
918.542.1547
Sky Ranch Contact Info:
7750 S 655 Rd
Quapaw, OK 74363
918.542.1547
MAIL COMPLETED REGISTRATION TO:
TRI-STATE DISTRICT
P.O. 3643
BARTLESVILLE, OK 74006
I affirm that I will obey all the rules of Sky Ranch and the Tri-State District of
The Wesleyan Church. I will strive to be Christ-like in my actions and words
and will show respect to the camp leaders, my roommates, other campers and
Sky Ranch property. I understand that failure to follow these rules could result
in my early dismissal from camp or punishment equal to my offense.
Camper Signature:___________________________ Date:________________
PARENT/GUARDIAN CONSENT:
I give consent for my child to join the Tri-State District of The Wesleyan
Church Youth Camp and I fully understand the rules that have been set forth
for my child to follow. The health information is correct, so far as I know, and I
give permission to the camp medical team to administer medical aid as
required for illness or injury under a physician’s orders (including
transportation to and from the necessary facilities).
Parent Signature:____________________________ Date:________________
MEDIA RELEASE:
I, the undersigned, do hereby grant or deny permission to the Wesleyan
Church to use the image of my child as marked by selection(s) below. Such
use includes the display, distribution, publication, transmission, or otherwise
use of photographs, images and/or video taken of myself or my child for use in
materials that include, but may not be limited to, printed materials such as
brochures and newsletters, videos, and digital images such as those on the
local, district, and general Wesleyan Church websites.
( ) Deny permission to use my image or my child’s image.
( ) Grant permission to use my image or my child’s image.
Parent Signature:____________________________ Date:________________