2016 Summer Camp Details Louisiana District Campgrounds -­‐ 1800 Hickory Hill Road, Pineville, LA 71360 On-­‐Line Registration CLOSES 11:50PM May 23rd, 2016 Event Coordinator—Paige Townsend Phone: 985.438.2134 Email: [email protected] Jr. Camp $130.00 (includes a camp t-­‐shirt) Online Registration Link: https://www.eventbrite.com/e/la-­‐district-­‐junior-­‐camp-­‐2016-­‐ages-­‐12-­‐15-­‐tickets-­‐24175328057 Sr. Camp $130.00 (includes a camp t-­‐shirt) Online Registration Link: https://www.eventbrite.com/e/la-­‐district-­‐senior-­‐youth-­‐camp-­‐2016-­‐ages-­‐16-­‐21-­‐tickets-­‐24211679786 Consent & Certification Form Link: [EACH CAMPER MUST COMPLETE & BRING TO CAMP] https://www.dropbox.com/s/9lxudshmshud07a/2016CampConsentandCert.pdf?dl=0 Remember each attendee needs to complete the 2016 Consent and Certification form and bring the form with them when they check-­‐in for camp. The form must contain all appropriate signatures including the Pastor. Louisiana District United Pentecostal Church - Camp Student Registration Form 2016
CONSENT AND CERTIFICATION
CAMPERS PRINTED NAME:_________________________
I, the undersigned, being the parent/guardian of the child named above (“child”), do hereby consent to the participation of my child in all
of the scheduled activities during the Louisiana District Kids Camp for the year 2016, and any other activities customarily associated
with this camp. Further, I certify that my child is physically fit and adequately prepared to participate in all sporting events (unless
otherwise noted in medical information). If my child is involved in any destructive behavior or vandalism, I understand that my child and
I will be financially responsible for their actions.
MEDICAL TREATMENT AUTHORIZATION. I understand that I will be notified in the case of a medical emergency. However, in the
event that I cannot be reached, I authorize the calling of a doctor and the providing of necessary medical services in the event my child
is injured or becomes ill. I authorize any one or more of the following persons to make emergency medical care decisions on behalf of
my child if required by law or a health care provider. I, ____________________, understand the Louisiana District UPCI will not be
responsible for medical expenses incurred solely on the basis of this authorization. I agree to notify the Camp in the event of
any health changes that would restrict my child’s participation in any normal camp activities. I also understand that the adult
supervisors reserve the right to restrict my child from any activity that they do not feel is within the physical capabilities of my child.
HEAD LICE POLICY. All campers will be required to have their hair checked for head lice by the camp nursing staff before registration
will be completed. If lice/nits are found, the camper will not be allowed to complete registration. The personnel in charge of the
camper during camp will be asked to notify the child’s parental guardian. We ask that all church guardians stay with their youth until
registration is completed. If a child is found with lice/nits after registration, the Pastor/Parent/Guardian will be contacted to a) return the
camper home, b) arrange treatment (Camp staff will not provide treatment). The camper can be readmitted only if properly treated, and
a letter is presented from Pastor/Parent/Guardian/Physician stating the same and the camper must be re-checked by camp nurse to be
certified lice/nit free.
PRE-REGISTRATION INFORMATION
Pre-Registration will only be available on-line by following the link from the Louisiana District website at www.ladistupc.com.
The On-Line Pre-registration deadline is Monday night May 23rd for all camps.
REFUND POLICY
Due to the cost of supplies purchased in advance and workers hired, all registrations are non-refundable.
* NOTE:
Every application must have the following three signatures in order to be processed.
I will abide by Camp rules and dress code, and be respectful, courteous and cooperative at all times!
1. CAMPER SIGNATURE_____________________________________________
DATE
_______________
I have reviewed the above information, including specifically the Consent and Certification, Medical Treatment Authorization, and Head
Lice Policy sections. I do hereby grant authorizations as requested.
2. PARENT/GUARDIAN SIGNATURE__________________________________
DATE
_______________
DATE
_______________
By my signature, I am approving this camper for attendance at the Youth Camp indicated:
3. PASTOR SIGNATURE_____________________________________________
Each Camper must bring the completed form to Registration
•On-Line Pre-registration - $130.00 (includes a camp t-shirt)
•Onsite Registration - $150.00 - Does NOT include a camp t-shirt.
•Check-in and Onsite Registration begins at 1:00 PM on the Monday of camp
Kids Camp
•Camp ends at 10:00am on Friday June 10, 2016 with the camp office closed at 11:00am
Junior Camp
•Camp ends at 12:00pm on Friday June 17, 2016 with the camp office closed at 1:00pm
Senior Camp
•Camp ends at 12:00pm on Friday June 24, 2016 with the camp office closed at 1:00pm