Microsoft word - edited winter_retreat_red_river_2012_registration_packet.doc

Winter Retreat 2012 – Red River Presbytery – January 14 –15
Registration is 2-part, both parts must be complete or you are NOT registered, both are due no later than Jan 4. 1) Payments are accepted on-line only and cost is $55 per person,
2) Registration forms must be filled out & turned in to St Matthew. Forms are available at St Matt info stations, or there is a link on the payment page to print the forms yourself. MEDICAL INFORMATION
Can the camper be given over-the-counter medications (i.e. Benadryl, Pepto Bismol, Tylenol, etc.) Does the camper have any medical conditions we should be aware of (i.e. Asthma, Diabetes, Seizures, Allergic Reactions to medication or food, Sleep Walking, Night Terrors, etc. please list) Please list all medications camper is taking / bringing to camp ALL MEDICATIONS MUST BE IN ORIGINAL CONTAINER LABELED WITH CAMPERS NAME / DOSAGE
AND MUST BE TURNED IN TO THE NURSE UPON ARRIVAL AT CAMP
MEDICAL RELEASE
I hereby give permission to the nurse or the medical personnel selected by the camp administration to provide routine health care; to administer medications; to order X-rays, routine tests, treatment; to release any records necessary for insurance purposed; and to provide or arrange necessary related transportation for 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 the person named above. Parent Covenant: I fully support my child’s participation in the Red River Summer Camp Program. I will pray for and
encourage my child to be an active and full participant in the activities throughout camp. I understand that movies being
shown at camp for small groups and worship are reviewed and edited and that both PG and PG-13 movies are used. I
understand that cell phones are only allowed for limited use at camp. Therefore, I agree not to call or send text messages to my
child except during designated free-times and will only expect to hear from my child during those allotted times. I understand
that the camp staff has the best interests of the campers in mind and do all they can to support and encourage campers while
they are in their care. I will work in prayerful cooperation with camp staff to provide my child with the
best experience possible.
Camper Covenant: I agree to be a full participant and to follow the rules and guidelines of the Red River Summer Camp
Program. I understand the actions I may take to break any rules or guidelines may lead to my leaving camp early and a
possibility of not returning for future camps. I agree to respect all camp staff members involved in the summer camp
program, understanding that it is their job to have my best interests in mind while I am in their care.
If you have questions please contact Lisa Stokes at [email protected] or call 817-295-5832 To make on-line payment go to www.stmattcpc.org Fill out then return this form to St Matthew.

Source: http://stmattcpc.net/family/images/Winter_Retreat_Red_River_2012.pdf