Dear Parent,
We are so excited that your daughter will be joining us at NeKaMo Camp this summer! We
hope she has a great camping experience as she meets new friends, learns new skills, explores
God’s Word, and has lots of fun!
This packet contains:
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Information about spending money, what to pack, camp address, etc.
Check out these links about preparing your daughter for camp http://www.campparents.org/homesickness
http://www.acacamps.org/blog/parents-place/preparing-camp-tips-campers-andparents
Also attached are:
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Permission forms to attend camp
Parent Questionnaire
Health Form (physical exam NOT required, but health and immunization history are)
Behavior Expectations Agreement
Camper Release Form
Please print them off, fill them out, and bring ALL forms to camp.
If you have any questions, please call me at 816-225-5269.
Sincerely,
Krista Crank
Registrar
HEALTH FORM
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A physical examination is NOT required. However, a parent or guardian must complete
the health form. Please pay close attention to the immunization history.
Because camp is a structured, learning environment, we recommend that A.D.D. children
who take medication during the school year continue it during their week at camp.
All medicine is given to the camp nurse and is distributed as needed. A registered nurse
will be at camp, and parents will be contacted if a camper should require treatment by a
physician or infirmary care for more than a 24-hour period.
MEDICATIONS MUST BE IN THEIR ORIGINAL PRESCRIPTION BOTTLES!!!
It would be helpful if vitamins and other supplements were NOT sent to camp to add to
the nurse’s workload.
SPENDING MONEY
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Each camper turns in all her spending money to the Business Manager during
registration. Whatever a camper spends during the week is subtracted from her account,
and the remainder is returned at the close of camp.
Some of the items for sale in the Tuck Shop are stuffed animals, water bottles, drawstring
backpacks, postage stamps, postcards, jewelry, and small toys. Also offered in restricted
quantity are candy, pop, and ice cream.
An offering is collected each week for a missionary from our camp or other specific
need. Parents may want to discuss with their daughters an amount that would be
appropriate if they want to contribute.
MAIL CALL!!!
A letter or card is ALWAYS welcome at camp. The address is:
Your daughter’s name
NeKaMo Camp
c/o Camp Cumcito
13220 Mission Rd.
Warsaw, MO 65355
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Write soon and often! However, please DO NOT send food or candy.
If an emergency should occur at home, you may contact your camper through the camp
office: (660) 438-5253.
No outgoing calls are allowed except in extreme circumstances.
No visitors are allowed during the week except in extreme circumstances and must be
cleared with the director.
PACKING LIST (writing your name on your belongings is a good idea!)
Mark your items clearly and remember to bring everything home that you brought with you.
Tennis shoes are great at camp.
Bring at least one pair of enclosed, hard sole shoes. Sports sandals must be sturdy with straps.
Flip-flops and flimsy sandals are only to be worn to the pool and the shower house.
-completed and signed forms (Health history, Parent Questionnaire, Camper Release, Behavior
Expectations, Permissions)
-spending money (turn in to the Business Manager on Registration Day)
-Bible, notebook, pencil
-Stationery, stamps, envelopes
-Sleeping bag or bedroll, twin sheets recommended
-Pillow
-Ground cloth - waterproof
-Flashlight
-Camera - optional (no cell phones)
-Insect repellent
-Glasses / contacts
-Comb & brush
-Soap & shampoo
-Deodorant
-Toothbrush / paste
-Washcloths & towels
-Swimsuit (modest) & beach towel
-Shirts, tops
-Pants, jeans, shorts
-Underwear
-Pajamas
-Socks - lots
-Tennis shoes or hard sole shoes (required)
-Sandals for pool/shower
-Raingear
-Sweats, jacket
-Dirty clothes bag
LOST & FOUND
If your daughter does not get home with everything she took to camp, check with Debbie Morris
at (913) 764-7240. Items will be held for only one month after camp.
WHAT NOT TO BRING:
- NO expensive clothes (this is camp!)
- NO ipods
- NO cell phones
- NO other electronic equipment
- NO magazines or posters
- NO gum, candy, or food
- NO cigarettes, alcohol, or drugs
- NO bikinis
- NO camisole-style tank tops or half-shirts
- NO clothing with inappropriate slogans
- NO weapons of any kind
- NO pets
Below are all the forms to be printed off. . . . . . . . . .
BRING TO CAMP
PERMISSION TO ATTEND
Camper’s Name _______________________________________________________________
I give permission for my child to attend NeKaMo Camp, participate in activities, have her
photograph, if taken, used for camp publicity, and receive emergency medical treatment if
necessary.
Custodial Parent/Guardian
Signature _____________________________________________
Date ___________________________
BRING TO CAMP
(For Explorers – going into 10th-12th
grades)
EXPLORER PERMISSION FORM
(for grades 10-12)
You have my permission for my daughter ___________________________________________
to go, with appropriate adult supervision, to Warsaw for an Explorers Outing and to go offsite
for cookouts and special boating activities.
Parent signature ________________________________________________________________
Date _________________________________________
BRING TO CAMP
PARENT QUESTIONNAIRE
In a few weeks your child will be living in a cabin with other campers the same age. We want to encourage each
camper’s growth to the fullest. Please fill out the questionnaire and turn it in on registration day. If there is
anything confidential which you would not want kept in the camp files, please attach a note.
Name of Camper ____________________________________________________________________
Has your child been to camp before? ______________ If yes, when and where? __________________
If not, has your child been away from home alone more than two days? ___________________________
Who lives in the camper’s home? (names please)
Father
_______________________________
Occupation____________________
Mother
_______________________________
Occupation____________________
Brothers
_______________________________
Older_________ Younger________
Sisters
_______________________________
Older_________ Younger________
What responsibilities does your child have at home?
What personality traits best describe your child? (shy, outgoing, cheerful, strong-willed, sensitive, calm, easygoing,
restless, alert, moody, aggressive, etc.)
How does your child relate to family, peers and authority figures?
What are your child’s greatest interests?
Does your child like school?
What do you want your child to get out of camp?
Physically:
Socially:
Spiritually:
Any special facts we should know in order to better understand and help your child? (allergic, disabled,
hypersensitive, etc.)
Are there any activities that you do not wish your child to participate in?
Is there anyone other than you authorized to make decisions for your child on behalf of you in the event you
cannot be reached? (Grandparents, other parent, friend, etc.) If so, please list name(s) and day and evening
phone numbers below.
Authorized Contacts:
(1)_________________________________ relationship: __________ phone ____________________
(2)_________________________________ relationship: __________ phone ____________________
Signature of parent ____________________________________________ Date ___________________
BRING TO CAMP
HEALTH HISTORY FORM page 1
To be filled in by camper’s parent/guardian or staff member.
Name_____________________________________________________________________________________
Last
First
Middle
Date of Birth __________________________ Age ______ Sex _____________
Parent/Guardian (or Spouse) ______________________________________
Home Phone (
)______________
Home Address _________________________________________________
Work Phone (
)_______________
If not available in an emergency, notify:
Name ________________________________________________________ Home Phone (
)______________
Address ______________________________________________________
Work Phone (
)______________
OR Name ______________________________________________________
Home Phone (
)______________
Address ______________________________________________________
Work Phone (
)______________
HEALTH HISTORY: (check-–giving approximate dates)
Bleeding/Clotting Disorders ________
Diabetes ________
Ear Infections (frequent) ________
Epilepsy or Convulsions ________
Heart Defect/Disease ________
High Blood Pressure ________
Diseases
Allergies
Chicken Pox ________
Whooping Cough ________
______________ ________
______________ ________
Asthma ________
Food ________
Hay Fever ________
Insect Stings ________
Ivy Poisoning, etc. ________
(For Female): Has this person menstruated? ________
If not, has she been told about it? ________
If so, is her menstrual history normal? ________
Special considerations ___________________________________________
Penicillin ________
Other (list)
_______________ ________
_______________ ________
List date(s) and describe:
Disability or chronic/recurring illness
_________________________________________________________________
Operations or serious injuries ______________________________________________________________________
Recent illness or hospitalization ____________________________________________________________________
Name of family physician ____________________________________________ Phone (
)__________________
Name of dentist/orthodontist _________________________________________ Phone (
)__________________
Name of family medical/hospital insurance carrier ______________________________________________________
Policy or group number ___________________________ Name on the policy _______________________________
AUTHORIZATION FOR TREATMENT MUST BE COMPLETED
This health history is correct so far as I know, and the person herein described has permission to engage in all
prescribed activities except as noted. I hereby give permission to the physician selected by the camp director to order
X-rays, routine tests, and treatment for the health of my child, and in the event I cannot be reached in an emergency, I
hereby give permission to the physician selected by the camp director to hospitalize, secure proper treatment for, and
to order injection and/or anesthesia and/or surgery for my child as named above. This form may be photocopied for
use out of camp. I agree to the release of any records necessary for treatment, referral, billing, or insurance
purposes.
Signature ______________________________________________________________ Date ___________________
Camp Nurse ___________________________________________________________ Date ___________________
The back side of this form must be completed too! → → → → → → → → → → → →
HEALTH HISTORY FORM page 2
Last Name: _________________________________________ First Name: ________________________________
CURRENT MEDICATION:
Name of medication
Dosage
When taken
Reason for taking
NOTE: ALL MEDICATION brought to camp (listed above),
including vitamins and supplements, must be in
ORIGINAL CONTAINERS with user’s name printed on
them and labeled with directions for use.
IMMUNIZATIONS-–
IMMUNIZATIONS Record the date (month/year) of immunization and/or most recent booster:
IMMUNIZATION
Date Last Received
IMMUNIZATION
DTP Series
Tetanus
Measles
Tuberculin test (most recent)
Mumps
Other
Date Last Received
Polio
Rubella (German Measles)
The applicant is under the care of a physician for the following condition(s): _________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Current treatment (not including medications listed on front page): _________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Medication to be administered at camp (if different from previous list on front page): __________________________
______________________________________________________________________________________________
Medically prescribed meal plan or dietary restrictions: __________________________________________________
_____________________________________________________________________________________________
______________________________________________________________________________________________
Any activity restrictions? (Swimming, diving, strenuous activity) ___________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
BRING TO CAMP
BEHAVIOR EXPECTATIONS AGREEMENT
Dear Parents:
Here at NeKaMo Camp we strive to maintain an atmosphere of fun and friends. One way we do this is
by specific policies regarding camper behavior and program procedures. We are dedicated to
upholding these policies in order to ensure the safety of your child while at camp. The following is a
brief overview of our behavior policy. Please feel free to address any questions or concerns you have
with the division director or administrative staff.
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Campers are expected to respect the feeling and rights of others. Campers will be held accountable for
how they treat others and how they speak to others.
Profanity is NOT acceptable at NeKaMo Camp.
Insubordination (including, but not limited to: refusal to follow directions, back-talking, negative
posturing, etc.) toward a staff member will NOT be tolerated.
If the camper’s behavior cannot be corrected through the camp’s behavior modification program, the
parent will be notified to take the camper home. NeKaMo’s behavior modification policy is a five-step
program in positive discipline. With a counselor, a camper works through problem solving and conflict
management – identifying the problem, suggesting solutions, and choosing her own consequences
where necessary. She is given four opportunities to correct inappropriate behaviors, and on the fifth
offense, she will be sent home. Parents will be notified after the occurrence of a third offense and will
be involved in the process from that point.
The following offenses will result in immediate dismissal from camp with no second chances:
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Hazing
Failure to live within the established physical boundaries of camp
Vandalism/Property damage (camp or personal) – parents will be responsible for the replacement or
repair of damaged property.
Use or possession of drugs, alcohol, or tobacco. (Both parents and the proper authorities will be
notified.)
I have read and agree to the above policies for NeKaMo Camp. My child has also been made aware of
these policies. I understand that I will be held responsible for my child’s actions during her stay at camp
and consent to pick her up should the need arise. No reimbursement of camp fees will be made. I
realize that I will be made aware of a problem before the decision is made to remove my child from
camp (except for the offenses listed above.)
Parent signature ______________________________________________ Date _____________
Camper_______________________________________________________________________
Division: PF grades 2-4____ TB grades 5-6____ CH grades 7-9____ EX grades 10-12____
Week 1____Week 2____Both weeks____
BRING TO CAMP
CAMPER RELEASE INFORMATION
Dear Parent,
Your child’s safety is of great concern to us. Therefore, we ask that you give us the name of the individual who will be
picking up your daughter on departure day. Please fill out the form below with the information requested.
If it should become necessary for someone other than the person listed to pick up your daughter, please call the camp
before the end of the week at: 660-438-5253. For later reference, this information can be found on the form “The Clue."
Camper name _____________________________________________________________________________________
Week 1___Week 2___Both wks___ Division: PF grade 2-4____TB grade 5-6____CH grade 7-9____EX grade 10-12____
Parent name ______________________________________________________________________________________
Home Phone ______________________ Mother’s Cell ______________________ Father’s Cell ___________________
Parent signature __________________________________________________ Date ____________________________
At the end of camp, my child will be picked up on Saturday by: (Choose One)
□ Parent or legal guardian ___________________________________________________________________________
□ Other individual __________________________________________________________________________________
□ Early pick-up (Approved by the Director) Date: ___________ Time: ___________ Identify above, who will pick-up child.
For 2 week campers:
Between the two camp weeks my child will: (choose one)
□ Stay over the weekend at camp - (In order to stay, Weekend Stay must be included in your child’s Total Camp Fee)
□ Leave camp for the weekend and be picked up by:
___ Parent or legal guardian _____________________________________________________________________
___ Other individual ____________________________________________________________________________
-----------------------------------------------Section below to be filled out on departure day------------------------------------------------For office use:
Counselor ______________________
Call received to change instructions:
Pick up by _______________________
Caller ___________________________
Date ____________________________
Received by
______________________
Last day of camp, camper released to:
Signature_______________________________________________
Date ___________________________________
Over the weekend, camper released to:
Signature_______________________________________________
Date ______________________________