JULY 9-13, 2015 CAMP WOW COST: THIS FORM IS DUE BY

(1)

!

JULY 9-13, 2015

CAMP WOW

COST: ______

THIS FORM IS DUE BY _______

!

$250

(2)

Dayspring WOW

is a five day high school camp help

at Camp WOW in Stuart, OK (www.campwow.com).

Last year Dayspring East and Dayspring WOW came

together for a week full of worship, teaching, small

groups, games and recreation. Join us this year

alongside speaker Brock Morgan, worship leaders Ben

Freeman and Shelly Paige, and friends from churches

all over Oklahoma as we worship, play and laugh

together. We will seek God through meaningful

discussion in small groups, breakout sessions, church

chat and more. Not to mention there’s plenty of time to

play in rec, free time, and late night activities!

That’s a lot of great stuff to pack into 5 days!

DON’T MISS IT!

SPEAKER:

Brock Morgan began his career as a youth

worker about 24 years ago and he has never looked

back. He is a popular speaker for camps, retreats, and

conferences. He has been delighted to inspire and

encourage youth and youth workers alike with God’s

amazing love. He has written a few well-received books, including Youth Ministry in a

Post-Christian World. His newest book, The Amazing Next, targets both seniors in high school and

college students. Currently Brock is the Youth Pastor at Trinity Church in Greenwich, Connecticut

where he lives with his wife and daughter. They are in the midst of adopting and would covet your

prayers.

BAND:

Ben Freeman & Shelly Paige will be joining us again this year! Ben currently leads worship

for the contemporary services at New Covenant UMC in Edmond, OK and travels with Passion

recording artist Charlie Hall, playing guitar and keys in Charlie’s band.

Shelly is a musician,

songwriter, worship leader. She is currently on staff as the Director of Worship at New Covenant

UMC in Edmond

DRESS CODE:

Read this before you pack! So here’s the deal. We do not want to be the

fashion-police. That is not why leaders come to camp. So don’t bring the stuff you know we won’t like!

Shorts must be fingertip length or longer. Midriff and back must be covered at all times. Tank tops

are ok but no spaghetti straps, cami’s or “muscle tanks” (AKA deep armpits). Girls: no tank tops

that show skin underneath your bra under your arms. Swimsuits: Girls—conservative one piece.

Guys—boxer style trunks.

PACKING LIST:

Here are the basics of what to bring:

! Bible, journal, pens

! Bedding (sheets, sleeping bag, pillow)

! Toiletries & towels

! Clothes & PJs for the week

! Modest swimsuit

! Sunglasses & sunscreen

! Sandals, tennis shoes, shower shoes

! Flashlight

! Camera

! Medication (to turn in at check-in)

! Camping chair—optional but

recommended for small group time

! A few bucks for the snack shack

! Attire for western night (late night)

! Attire for blacklight night (late night)

Here’s what to leave at home: Anything that could get you sent home, anything you would be sad

to lose, extra cash, cell phones, iPods, headphones, etc. Try unplugging for a week. It’ll do you

good. Camp is about relationships anyway.

(3)

!

DAYSPRING 2015 REGISTRATION

JULY 9-13 – CAMP WOW

PLEASE PRINT

First & Last Name: _________________________________________________________

Grade in Fall 2015: ________

Circle one: Camper / Leader / Design Team / Dean

Home phone: () Parent Cell phone: ()____

Student Cell phone: ()______

Church: __________________________________________________________________

T-Shirt Size: Circle one (adult sizes) Small / Medium / Large / X-Large / 2XL / 3XL

Please list the names of two students in your grade that you might like to be in a group

with: 1) _ 2) _

COVENANT OF CONDUCT

In all meetings, or other events under the sponsorship and/or guidance of my church, I am

a representative of that Christian community and I am responsible for my actions. I

understand the following guidelines will be followed:

1. The use of illegal drugs, possession of alcoholic beverages, all tobacco products and

weapons are prohibited on the campgrounds and other event locations.

2. All conduct shall be in keeping with the highest Christian regard and respect for all

persons.

3. All dress shall be in good taste and appropriate for a Christian witness, and in

keeping with camp’s dress code guidelines.

4. Campgrounds will be left clean and without graffiti. I will abide by all campground

rules and regulations.

5. I will comply with the Oklahoma Conference Social Networking and Blogging Policy

(may be found online).

I have read and understand this covenant. To the best of my ability, I agree to

abide by it. I understand that the violation of any terms of this covenant may

result in my being sent home.

CAMPER’S SIGNATURE: ____________________ DATE:

PHOTO RELEASE

I consent to the use of this camper’s image or voice in photographs, audio and/or video

recording taken during the course of this camp for the purpose of publicizing the camping

program of the Oklahoma Conference of The United Methodist Church.

P

arent/Guardian’s Signature: _________________________ Date: _

(4)

Walk on Water

Agreement to Participation

Assumption of Risk and Release of Liability

PLEASE READ BEFORE SIGNING

The undersigned acknowledges that during the session that the applicant has requested to participate in, Certain risks and danger may occur. The undersigned recognizes that such risks and danger may include Loss or damage to personal property, physical or psychological damage and/or injury, not excluding fatality due to accident. I certify that I am completely healthy (both physically and emotionally) and capable of participating in this session. I have listed on the medical information form medical conditions

That WALK ON WATER Inc. should be aware of which may hinder my participation in the session. However, I understand that it is solely my responsibility to determine whether there is any medical reason That I should not participate in the session and to obtain approval for any and all activities from the appropriate Health-care providers. The health history is correct as far as I know, and the person herein described has permission To engage in all prescribed camp activities except as noted. I hereby authorize the medical personnel selected by The camp director and/or church leader to order x-rays, routine tests, treatment, and necessary transportation for Me/my child as deemed necessary. I, individually and on behalf of the minor and all other family members, Executors or administrators, do hereby release, forever discharge, and agree to hold blameless WALK ON WATER Inc. and its counselors, staff, employees, agents, and lessors from any and all liability, claims, INCLUDING, BUT NOT LIMITED TO THE NEGLIGENCE OF WALK ON WATER Inc. STAFF, DIRECTORS, COUNSELORS, EMPLOYEES, AGENTS and LESSORS, or demands for personal injury, sickness, or death, as well as property Damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the participant While said person is participating at WALK ON WATER. In consideration of, and as part payment for, the Right to participate in such a program and the services arranged for me by WALK ON WATER Inc. its staff, Directors, counselors, employees, agents and lessors, from any and all liability, actions, causes of action, INCLUDING BUT NOT LIMITED TO THE NEGLIGENCE OF WALK ON WATER INC DIRECTORS, COUNSELORS, EMPLOYEES, AGENTS and LESSORS, debts, claims, and demands of every kind and nature Whatsoever, whether for bodily injury, property damage or loss otherwise, which I now have or which may arise From or in connection with my program or participation in any other activities arranged for me by WALK ON WATER Inc. its staff, directors, counselors, employees, agents, and lessors, for all members of my family,

Including any minors accompanying me. I SPECIFICALLY AGREE THAT MY AGREEMENT TO INDEMNIFY AND HOLD HARMLESS WALK ON WATER INC. ITS STAFF, DIRECTORS, COUNSELORS, EMPLOYEES, AGENTS and LESSORS, INCLUDES ALL LITIGATION COSTS AND ATTORNEY FEES FOR ANY

LITIGATION BROUGHT ON BY MYSELF, ON BEHALF OF THE MINOR, IF APPLICABLE, OR ANY OTHER FAMILY MEMBER. I grant permission to WALK ON WATER to use photographs and any video taken by WALK ON WATER for use on web sites or other electronic form or media, without notifying me. I hereby waive any right to inspect or approve the photographs or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the photographs. I hereby agree to release and hold harmless WALK ON WATER, via electronic or media, from and against any claims, damages or liability arising from or related to the use of the photographs, including but not limited to any re-use, distortion, blurring, alteration, optical illusion or use in composite form, either intentionally or otherwise, that may occur or be produced in production of the finished product. I also state that I am not under, and will not be under the influence of any Chemical substance including alcohol. I fully understand that my physical activity involves risks of injury. I also understand that my participation in this WALK ON WATER Inc. program is entirely VOLUNTARY. I enter into this session and take full responsibility for my decision to participate or not to participate and agree To follow all safety instructions.

____________________________________ ___________________________________ _________________ Name of Participant (please print) Signature of Participant Date

(If under 18, parent or guardian must sign) _____________________________________ ________________________

(5)

PAGE 1

www.okcamps.org 1501 NW 24th St., Oklahoma City, OK 73106-3635

Oklahoma United Methodist Camp and Retreat Ministries

Camper Health Information

Form A

Submit complete form at time of registration.

Email: [email protected] Fax: 405-530-2049

Mail: OKUMC Camps

1501 N.W. 24th St., Oklahoma City, OK 73106

INSTRUCTIONS

To Parent(s)/Guardian(s):

COMPLETE pages 1, 2 and 3 of the Camper Health Form (Form A) and make a

copy. Send signed form to the camp office at time of registration by one of the following ways.

1) Complete, sign, scan and email Form A 2) Complete, sign, and fax Form A

3) Complete, print, sign, and mail Form A to the Camp’s office Dates will attend camp: from ______ / ________ / ______ to _____ / ______ / ________CAMP CODE: __________________ Camper Name: _________________________________________________________________________________________

q

Male

q

Female Birth Date _______ / _______ / ________ Age on arrival at camp: ______________________________

Month/Day/Year

Month/Day/Year First/Middle/Last

Month/Day/Year

GENERAL INFORMATION

Camper’s Home Address: Street ___________________________City ___________________________ State _______ Zip Code _______________

Parent/guardian with legal custody to be contacted in case of illness or injury:

Name: ______________________________ Relationship to Camper: ____________Phone: ( _______ ) _________ or ( _______) _____________ Email: ___________________________________________________________

Home Address: Street ____________________________________City ___________________________ State _______ Zip Code ______________ (If different from above)

Second parent/guardian or other emergency contact:

Additional contact in event parent(s)/guardian(s) can not be reached:

ALLERGIES

No known allergies.

q

This camper is allergic to:

q

Food

q

Medicine

The environment

q

(insect stings, hay fever, etc.)

Other

q

_____________________________________________

Please describe below what the camper is allergic to and the reaction seen.

1501 NW 24th St., Oklahoma City, OK 73106-3635 www.okcamps.org

IMMUNIZATIONS

Provide the month and year for each immunization. Immunizations in brackets ( ) must be current. Copies of immunization forms from health-care providers or state or local government are acceptable; attach to this form.

If your camper has not been fully immunized, sign the following statement: I understand and accept the risks to my child from not being fully immunized.

Parent/Guardian _______________________________ Date: _______ / _____ / ______________ Relationship to Camper: ________________ IMMUNIZATION Dose requirements (mm/yyyy) month/year

Diphtheria, tetanus, pertussis (DTaP) or (TdaP) #1 #2 #3 #4 #5 Tetanus booster (dT) or (TdaP) #1 most recent dose – month/year

Mumps, measles, rubella (MMR) 2 Doses #1 #2

Polio (IPV/OPV) #1 #2 #3 #4

Haemophilus influenzae type B (HIB) #1 #2 #3 #4

Pneumococcal (PCV) #1 #2 #3 #4

Hepatitis B #1 #2 #3

Hepatitis A #1 #2

Varicella (chicken pox) #1 #2 Had chicken pox Date: Meningococcal meningitis (MCV4) #1

Tuberculosis (TB) test Date: _Negative

_q

_Positive

_q

q

This camper will not take any daily medications while attending camp.

q

This camper will take the following daily medication(s) while at camp:

___________________________________________________________________________________________________________________________ MEDICATIONS

“Medication” is any substance a person takes to maintain and/or improve their health including vitamins & natural remedies. Original pharmacy containers with labels which show the camper’s name and how the medication should be given are required.

Provide enough of each medication to last the entire time the camper will be at camp. Name of medication:

Date started Reason for taking When given

q

Breakfast

q

Lunch

q

Dinner

q

Other

Dose amount How it is given

Name of medication:

Date started Reason for taking When given

q

Breakfast

q

Lunch

q

Dinner

q

Other

Dose amount How it is given

PARENT/GUARDIAN AUTHORIZATION FOR HEALTH CARE:

This health history is correct and accurately reflects the health status of the camper to whom it pertains. The person described has permission to participate in all camp activities except as noted by me and/or an examining physician. I give permission to the physician selected by the camp to order x-rays, routine tests, and treatment re-lated to the health of my child for both routine health care and in emergency situations. If I cannot be reached in an emergency, I give my permission to the physician to hospitalize, secure proper treatment for, and order injection, anesthesia, or surgery for this child. I understand the information on this form will be shared on a “need to know” basis with camp staff. I give permission to photocopy this form. In addition, the camp has permission to obtain a copy of my child’s health record from providers who treat my child and these providers may talk with the program’s staff about my child’s health status.

Signature of Custodial Relationship

Parent/Guardian ____________________________________ Date: ______ / ______ / ______ Relationship to Camper: ________________ If for religious or other reasons you cannot sign this, contact the camp for a legal waiver which must be signed for attendance.

Camper Name: ___________________________ Birth Date / _ / ______

Month/Day/Year

Camper Health Information

Form A – PAGE 2

(7)

PAGE 3

www.okcamps.org 1501 NW 24th St., Oklahoma City, OK 73106-3635

Camper Name: ___________________________ Birth Date / _ / ______

Month/Day/Year

Camper Health Information

Form A – PAGE 3

Date of the camper’s last physical exam (M/Y): NON-PRESCRIPTION MEDICATIONS

The following non-prescription medications may be stocked at camp and are used on an as needed basis to manage illness and injury.

No continues to affect the camper’s life? (History of abuse,

death of a loved one, family change, adoption, foster care, new sibling, survived a disaster, others)

Explain “Yes” answers in the space below, noting the number of the questions. The camp may contact you for additional information.

HEALTH CARE PROVIDERS

Primary care doctor (s) ___________________________________

Phone ( ___________) ________________________________ Dentist (s) _____________________________________________ Phone ( ___________) ________________________________ Orthodontist (s) _________________________________________ Phone ( ___________) ________________________________ ADDITIONAL INFORMATION

Provide in the space below any additional information about the camper’s health that you think important or that may affect the camper’s ability to fully participate.

GENERAL HEALTH HISTORY

No

List Countries and dates:

Explain “Yes” answers in the space below, noting the number of the questions. The camp may contact you for additional information.

JULY 9-13, 2015 CAMP WOW COST: THIS FORM IS DUE BY

!

!

JULY 9-13, 2015

CAMP WOW

COST: ______

THIS FORM IS DUE BY _______

!

$250

Dayspring WOW

is a five day high school camp help

at Camp WOW in Stuart, OK (www.campwow.com).

Last year Dayspring East and Dayspring WOW came

together for a week full of worship, teaching, small

groups, games and recreation. Join us this year

alongside speaker Brock Morgan, worship leaders Ben

Freeman and Shelly Paige, and friends from churches

all over Oklahoma as we worship, play and laugh

together. We will seek God through meaningful

discussion in small groups, breakout sessions, church

chat and more. Not to mention there’s plenty of time to

play in rec, free time, and late night activities!

That’s a lot of great stuff to pack into 5 days!

DON’T MISS IT!

SPEAKER:

Brock Morgan began his career as a youth

worker about 24 years ago and he has never looked

back. He is a popular speaker for camps, retreats, and

conferences. He has been delighted to inspire and

encourage youth and youth workers alike with God’s

amazing love. He has written a few well-received books, including Youth Ministry in a

Post-Christian World. His newest book, The Amazing Next, targets both seniors in high school and

college students. Currently Brock is the Youth Pastor at Trinity Church in Greenwich, Connecticut

where he lives with his wife and daughter. They are in the midst of adopting and would covet your

prayers.

BAND:

Ben Freeman & Shelly Paige will be joining us again this year! Ben currently leads worship

for the contemporary services at New Covenant UMC in Edmond, OK and travels with Passion

recording artist Charlie Hall, playing guitar and keys in Charlie’s band.

Shelly is a musician,

songwriter, worship leader. She is currently on staff as the Director of Worship at New Covenant

UMC in Edmond

DRESS CODE:

Read this before you pack! So here’s the deal. We do not want to be the

fashion-police. That is not why leaders come to camp. So don’t bring the stuff you know we won’t like!

Shorts must be fingertip length or longer. Midriff and back must be covered at all times. Tank tops

are ok but no spaghetti straps, cami’s or “muscle tanks” (AKA deep armpits). Girls: no tank tops

that show skin underneath your bra under your arms. Swimsuits: Girls—conservative one piece.

Guys—boxer style trunks.

PACKING LIST:

Here are the basics of what to bring:

! Bible, journal, pens

! Bedding (sheets, sleeping bag, pillow)

! Toiletries & towels

! Clothes & PJs for the week

! Modest swimsuit

! Sunglasses & sunscreen

! Sandals, tennis shoes, shower shoes

! Flashlight

! Camera

! Medication (to turn in at check-in)

! Camping chair—optional but

recommended for small group time

! A few bucks for the snack shack

! Attire for western night (late night)

! Attire for blacklight night (late night)

Here’s what to leave at home: Anything that could get you sent home, anything you would be sad

to lose, extra cash, cell phones, iPods, headphones, etc. Try unplugging for a week. It’ll do you

good. Camp is about relationships anyway.

!

!

!

!

DAYSPRING 2015 REGISTRATION

JULY 9-13 – CAMP WOW

PLEASE PRINT

First & Last Name: _________________________________________________________

Grade in Fall 2015: ________

Circle one: Camper / Leader / Design Team / Dean

Home phone: (____)__________ Parent Cell phone: (____)__________

Home phone: () Parent Cell phone: ()____

Student Cell phone: ()______

with: 1) _ 2) _

CAMPER’S SIGNATURE: ____________________ DATE:

arent/Guardian’s Signature: _________________________ Date: _

_q

_q

Camper Name: ___________________________ Birth Date / _ / ______

Camper Name: ___________________________ Birth Date / _ / ______