9916 Lake Ave. So.
Spicer, MN 56288
(320)796-2181
www.gllm.org
Dear Campers,
Welcome to Green Lake Bible Camp! We are very excited about having you join us for camp this summer. It is going to be a great time
and we look forward to seeing you soon.
Your family is registered for Hope Abounds Family Camp starting on July 5th. Your balance is due by May 31st.
You will be receiving a call from our Program Director as camp gets closer regarding details for the program. If you have questions, please
contact Jeff at [email protected] or 320-796-2181, ext. 243.
Arrival Time: Registration begins Tuesday at 4 PM in the Chrysalis House Dining Room. If you must register after 4 PM, please contact
the camp in advance at 320-796-2181 and let us know when to expect you.
Departure Time: Camp ends on Friday, July 8th at 1 PM following a brunch and a closing worship service.
Mail and E-Mail: The camper’s address for the week is…
Mail: Your Name
Hope Abounds
Green Lake Bible Camp
9916 Lake Ave. South
Spicer, MN 56288
E-mail: [email protected]
(Enter camper name and program in subject line.)
Housing: All housing is in motel style cabins. Bathrooms and
showers are located in your cabin, and linens are provided,
if desired.
Child Care: During certain portions of the day child care is
provided. However, for the majority of the day, children will be
the responsibility of the parents.
Phone calls are discouraged, unless an emergency.
Phone: (320) 796-2181
Fax:
(320) 796-6633
Location: Green Lake Bible Camp is located on the south side
of beautiful Green Lake, just 2 miles east of Spicer on Lake Ave.
South. (Kandiyohi County Road 10).
Green Lake Lutheran Ministries
9916 Lake Ave. So., Spicer, MN 56288
Green Lake (320) 796-2204  Fax (320) 796-6633
Shore of St. Andrew & St. Andrew Village (320) 354-2961
Camp House (218) 848-2277
Email: [email protected]  Website: www.gllm.org
What to Bring to Camp List
THINGS TO PACK FOR CAMP
*** Be sure all items are clearly marked with camper’s name! ***
(You may want to print an extra copy to use as a check list when packing to go home)
___ Balance Due
___ Completed Health Form
___ Sleeping Bag and Pillow
___ Shirts, pants and shorts
___ Jacket or Sweatshirt
___ Pajamas
___ Socks and underwear
___ Outdoor shoes and sandals
___ Non-revealing swimwear (no bikinis or speedos)
___ Beach Towel
___ Bath towel, hand towel, washcloth
___ Toothbrush and toothpaste
___ Soap in a container, shampoo, comb, brush, etc.
___
___
___
___
___
___
___
___
___
___
Prescription medications
Laundry bag
Suntan lotion
Insect repellent
Kleenex or handkerchief
Flashlight with fresh batteries
Bible
Pen/pencil and notebook
Canteen money to deposit in canteen account
Optional: Camera, semi-dressy clothes for Thursday
night banquet, white t-shirt for tie-dye
WHAT TO LEAVE AT HOME
 Food, candy and snacks
 Cell Phones or beepers
 Fireworks, lighters, matches, etc.
 Radios, headphones, IPods, MP3s
 Game systems or other electronics
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


Laser Pointers
Weapons, pocketknives, Leatherman’s
Controlled substances
Non-prescription medications
Inappropriate clothing
OTHER HELPFUL INFORMATION
Check-in, Departure, Locations, Maps, Addresses, and Emergency Info: Each camp location and program
varies in dates and times. Please refer to your camper registration confirmation notice for specifics.
Canteen: Snacks range in price from $1.00 - $2.00. Clothing: $3.00 - $50.00.
Health Forms - Allergies: If camper has medical concerns or allergies to foods and/or the environment, please
send the health forms to us in advance. Preparations and meal planning need to be made before the camper arrives.
Physicals and Immunizations: State law no longer requires physicals unless there are current health conditions or
activity limitations noted on the health form. If all immunizations are current, parents may indicate that on the health
form and may sign.
Roommates: Campers may request 2-3 roommates. Please request when registering, or contact Jackie at the
camp: 320-796-2181 or email: [email protected] before your camper arrives.
Insurance: GLLM carries secondary accident insurance on campers. In case of accident or injury, the camper’s
parents’ or guardian’s insurance will be the primary coverage.
Visitors: Camp visitors are welcome Sundays and Fridays. Visits during the week are not advised unless an
emergency.
9916 Lake Avenue South
Spicer, MN 56288
Phone: (320)796-2181
Fax: (320)796-6633
www.gllm.org [email protected]
Health History Form
(Print one form for each camper)
Legal Name ___________________________________________________ Birth Date _____/_____/________
Last
Sex
M
F
First
M.I.
Age ______
Legal Guardian and Emergency Contact Information
Parent/Guardian __________________________________________ Relationship ___________________
Home Address __________________________________________Home Phone (____) _______________
City ___________________ State ______ Zip _________ Cell Phone (_____) _______________________
2nd Parent/Guardian ________________________________________ Relationship __________________
Home Address __________________________________________Home Phone (____) _______________
City ____________________ State ______ Zip _________ Cell Phone (_____) _______________________
Alternate Emergency Contact __________________________________ Relationship ________________
Home Address __________________________________________Home Phone (____) _______________
City ___________________ State ______ Zip _________ Cell Phone (_____) _______________________
Health History
Check and give approximate dates
______ Frequent Ear Infection
______ Heart Defect/Disease
______ Convulsions/Seizures
______ Diabetes
______ Bleeding/Clotting Disorder
______ Hypertension
______ Mononucleosis
______ Psychiatric Treatment
______ Chicken Pox
______ Measles
______ German Measles
______ Mumps
Allergies
______ Hay Fever
______ Poison Ivy, etc.
______ Insect Stings
______ Penicillin
______ Sulfa Drugs
______ Other Drugs
______ Asthma
______ Other (specify)
_____________________
_____________________
_____________________
Has this camper ever required any psychiatric counseling or hospitalization? Yes
No
If yes, explain ________________________________________________________________________________________
Operations or serious injuries (dates) ______________________________________________________________________
Disability or chronic or recurring illness _____________________________________________________________________
Activities encouraged or limited by physician ________________________________________________________________
Dietary Modifications ___________________________________________________________________________________
Current Medications (send with instructions)
___________________________________________________________________________________________________________
_______________________________________________________
Other disease or details from above _______________________________________________________________________
For female campers under age 18 only: Has person menstruated? Yes
No
If no, has she been told about it? Yes No If yes, is her menstrual history normal? Yes No
Special considerations _________________________________________________________________________________
Name of dentist/orthodontist _______________________________________ Phone (______) _________________
Name of family physician _________________________________________ Phone (______) _________________
Date of last physical examination __________________ Does your family carry medical insurance? Yes No
If yes, company name ___________________________________________________________________________
Policy or Group # _____________________________ Individual who carries this coverage ____________________
Suggestions on health related information for camp personnel _______________________________________________________
_________________________________________________________________________________________________________
Doctor’s Report (only required if camper has major health concerns)
I have examined the person herein described and have reviewed his/her history. It is my opinion that s/he is physically able to engage
in camp activities, except as noted in the attached report. Please attach a list of medications to be administered at camp and
include specific dosages.
Physician’s signature ___________________________________________________ Date __________________
Physician’s name (print) ____________________________________________ Phone (______) ______________
Immunization History
Required immunizations must be determined locally. Please record the date (month and year) of basic immunizations and most recent
booster dates.
DTaP
{
or
Td
{
Vaccines
Diphtheria
Pertussis (Whooping Cough)
Tetanus
Tetanus
Diphtheria
Tetanus
Oral Polio (Sabin) TOPV
Injectable Polio (Salk)
Measles, Mumps, Rubella (MMR)
Varicella (Var)
Hepatitis B
Year of Basic Immunization
1. ____________________
2. ____________________
3. ____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
1. ____________________
2. ____________________
3. ____________________
Other _________________
____________________
Tuberculin test given ____________ (most recent)
Haemophilus influenza b (HIB)
____________________
Year of Last Booster
1. ____________________
2. ____________________
3. ____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
1. ____________________
2. ____________________
3. ____________________
____________________
____________________
Consent for Medication Administration
This section includes a list of medications that GLLM has in stock and is allowed to administer under medical direction. Please circle those
medications that you would allow the Health Care Staff to administer to your camper, if needed, and then sign the signature line #1. If you do not
circle one or more of the medications, that medication will not be administered and the staff will contact you by phone before giving that medication.
If you do not want the staff to administer any medications, sign signature line #2. Please note that all medications will be given according to
labeled directions based on your child’s health history.
Ibuprofen (Advil)
Pepto-Bismol (for nausea or diarrhea)
Benadryl (allergy symptoms)
Antiseptic ointment
Acetaminophen (Tylenol)
Hydrocortisone Cream (for insect
Sore throat spray
Imodium AD (anti-diarrhea)
bites)
Cough drops
Tums (for acid indigestion)
Silvadene ointment (minor burns)
Aloe Vera
Sudafed (sinus congestion)
Calamine Lotion (for skin irritations)
Robitussin DM (cold symptoms)
#1) I grant the health care staff of Green Lake Lutheran Ministries, as appointed by the camp physician, permission to administer the
medication(s) that I have indicated above. I understand that all medications will be administered according to labeled directions, and that
those medications which I did not circle, will not be given without my permission unless in the event of an emergency.
Parent/Guardian Signature ________________________________________________ Date _____________________
#2) I do not give anyone at Green Lake Lutheran Ministries the permission to administer medications without my permission. I understand
that I will be contacted by a GLLM staff member before any medications(s) are administered, unless in the case of an emergency.
Parent/Guardian Signature ________________________________________________ Date _____________________
Authorization
This health history is correct so far as I know, and the person herein descried has permission to engage in all prescribed camp actives,
except as noted by me and/or an examining physician. Authorization for treatment: I hereby give permission to the medical personnel
selected by the camp director to order X-rays, routine tests, treatment and necessary transportation for me/or my child. In the event I cannot
be reached in an emergency, I hereby give permission to the physician selected by the camp director to secure and administer treatment,
including hospitalization, for my child as named above. The completed forms may be photocopied for trips out of camp.
Signature _________________________________________________________ Date ______________________
Pertinent Health Information
Health Form – a physical exam by a doctor is not required unless there are health problems or activity limitations noted on the
enclosed health form.
Please sign the parents’ authorization on the back page and complete the immunization history on the back. Bring the health
form to camp registration. Do not send the form to the camp unless you have medical concerns we should be aware of prior
to the day you arrive at camp.
For everyone’s safety, state law requires that ALL medications brought to camp must be kept in the Health Center. This
includes all prescription and over-the-counter medications, including medicated creams and ointments. The only exception to
this rule is the use of Rescue Inhalers and Epi-pens.
Campers are allowed to visit the Health Center as needed to receive their daily medication. All medications must be in an
original pharmacy container with the correct name, date, and instructions on the bottle. The camp cannot give campers and
medications that are improperly labeled or not prescribed by a physician/practitioner. Over-the-counter medications should not
be sent/brought to camp by campers. The health center has a limited number of common over-the-counter medications in stock
(those listed on the back of the Health Form). Accordingly, Standing Orders for Health Care are provided for the camp by a
licensed physician- Dr. Youngs. This allows the GLLM camp nurse(s) to administer first aid and dispense medications such as
those listed on the back page of the health form.
The camp carries secondary accident insurance on each camper but does not carry health (sickness) insurance. In case of
accident or sickness, medical bills will be sent directly to the parents for them and/or their family health insurance to pay. In case
of accident, any “out-of-pocket” expenses paid by the family will be submitted to the GLLM insurance company.
On the enclosed health form, please complete the insurance company information provided. You may also photocopy your
insurance card and attach it to the health form.
Thank you for taking the time to look over this health & medical information so carefully. It is our goal to give the best care
possible to our campers while they are at camp. Your assistance in this matter is greatly appreciated and is so vitally important
when considering the safety needs of all who attend summer camp at Green Lake Lutheran Ministries.
Sincerely,
Dave Eliason
Jeff Engholm
GLLM Executive Director
GLLM Program Director