Summer Camp Registration

**If you are attending sports camp, we will be offering you the opportunity to go an Orioles Game on Friday, August 18 at 7:05pm, vs. The Los Angeles Angels. There are fireworks after the game. Ticket prices will be based on how many people we can get for a group rate, but should not exceed $15/person, and an adult is required to attend with the student. Families are welcome! Please pre-pay on your first day of camp with cash or a check made payable to: Good Shepherd UMC; Memo Line: Youth Programs--Orioles Game. If you are attending the game with more than one camper, please register your whole family for the game on one registration form (For example: 2 campers + 1 adult = 3 people attending. On Camper #1's form, select "3" from the drop down list. On Camper #2's form, click "no, we do not plan to attend the game."

Please remember that by going to the game with us, you are a representative of Good Shepherd United Methodist Church, Good Shepherd Youth Programs, and our community. Your behavior is expected to reflect this. Since it is a church-sponsored event, no alcoholic beverages, or other substances not allowed for campers, should be consumed during our time together. Thank you for helping to make this a positive event for all. If you do choose to consume items not permitted, we may ask your family to leave our group, and not participate in the remainder of our camps this summer.

Parent/Guardian Information

Name of Parent/Guardian 1 *

First

Last

Relationship to Student *

Daytime Phone Number of Parent/Guardian 1 *

Cell Phone of Parent/Guardian 1 *

Name of Parent/Guardian 2 *

First

Last

Relationship to Student *

Daytime Phone Number of Parent/Guardian 2 *

Cell Phone of Parent/Guardian 2 *

Health Information (Will be stored confidentially)

Please describe any health or medical conditions that our staff should be aware of when working with your student or in the case of emergency *

We will be serving lunch during the program. Does your student have any food allergies? Please list them. *

Please list any medical or non-food allergies *

Is your student currently taking medication? *

Yes No

Please list all medication your student is CURRENTLY taking *

Does your student take medication during the school year that they DO NOT take during the summer? *

Yes No

Please list all medication your child takes during the school year, but is NOT taking during camp *

Please list any medication your student will be bringing WITH THEM to camp (such as an inhaler). NOTE: Good Shepherd Staff are NOT responsible for administering ANY medication *

Physician Name *

First

Last

Physician Phone Number *

Physician Address *

Line 1

Line 2

City

State

Zip Code

Country

Insurance Information: Please provide a photo copy of your student's insurance card (both sides) no later than the start of the first day of camp. Your student WILL NOT be allowed to attend camp without this information. If you check the "no insurance" option, we will call you to discuss emergency procedures. We require a separate "permission to treat" form to be signed for each camper.

Choose One *

My child does not have insurance (Please enter "N/A" in the rest of the blanks)

Insurance Carrier *

Policy Number/Group Number *

Name of Insured *

First

Last

Employer/Group Name *

Name on Insurance Card *

First

Last

***Please plan to arrive early on the first day of camp. We will need you to sign permission to treat, permission to transport, waivers of liability, a student code of conduct, and a photocopy of your insurance card before your student is allowed to attend camp. These waivers may also be signed ahead of time by contacting Pastor Randy Keith via the contact forms located elsewhere on the website, by email at goodshepherd.youthprograms@gmail.com or by phone at 410-243-1129.***

By electronically signing below, I attest that the information contained on this form is accurate to the best of my knowledge and ability. I understand that this is an application and registration form, but that registration is NOT complete until you receive a confirmation of enrollment AND ALL waivers are signed in person AND we receive a photocopy of a current health insurance card.

I also understand that while the following does not represent an exhaustive list, a camper may be immediately dismissed from the program for the following reasons:
-Leaving the site or established boundaries;
-Bringing a weapon (defined as any object designed, used for, or capable of inflicting bodily harm or physical damage); alcohol; drugs; or any illegal substance to camp; a firearm; explosives; or anything else deemed inappropriate by the staff or volunteers;
-Inappropriate interaction (physical or verbal) from the participant and/or their parent(s)/guardian(s) with staff, volunteers, or any other program participant's (parent(s), guardian(s), and/or students); and
-Striking or hitting an employee, volunteer, or participants.

In the unlikely event that a program fills to capacity, I understand that I will be notified as soon as possible so that I can make other arrangements for my student.

I also agree to update the staff with any changes to the information I've provided in a timely manner.

Good Shepherd UMC
Summer Camps 2017

Registration Form

Participant Information

Parent/Guardian Information

Health Information (Will be stored confidentially)

Good Shepherd UMCSummer Camps 2017Registration Form﻿

Participant Information

Parent/Guardian Information

Health Information (Will be stored confidentially)

Good Shepherd UMC
Summer Camps 2017

Registration Form