Camper Forms — Faith Adventure Camp

You will begin the process of registering your camper by filling out the following forms. Because of the way they are used to serve your child at camp, they are divided into various sections, and because of this, there will be some redundancy of information required. Please fill out each form completely and press submit for each section as you complete it.

Pay $360.50 Camp Fee Now!

You may also pay by check in the amount of $350.00. See the Registration and Payments section on the PARENTS page of this site for details.

Camper Registration Form 2024

Camper Name

First Name

Last Name

Preferred Name

First Name

Last Name

Camp Session

Girl's Camp

Boy's Camp

Age

Birthdate

Grade completed before camp

Parent Name

First Name

Last Name

Email

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Church you attend (if applicable)

Camper's T-Shirt Size

Cabin Mate Preference

(must be no older or younger than one year of your camper in age)

Are you willing to drive additional campers to camp?

Message

Camper Acquaintance Information

Name

First Name

Last Name

Please list the people who live with the Camper and their relationship to him/her.

Special needs: (i.e. learning difficulties, hyperactive, bedwetting, allergies, etc.) Please be as specific as possible in order for us to make your child's week more comfortable. (For example: we recommend sending overnight pull-ups to avoid the embarrassment of wet sleeping bags, clothes, etc.)

Personality traits of your camper:

Reactions when tired:

Learning environment your child is used to and learns best from (i.e. public, private, or home school / hands-on, listening, visual, reading, etc.):

Responsibilities you child has at home:

What pets does your child have at home?

For girls, has she been told about menstruation?

Has she menstruated?

What else should we know about your camper?

Camper Medical Information

Camper Name

First Name

Last Name

Drug Allergies and Reactions

Emergency Contact

First Name

Last Name

Relationship to Camper

Phone

(###)

###

####

Secondary phone number

(###)

###

####

Email

Medical History

Please check any that apply to your child:

Frequent Ear Infections

Bleeding / Clotting Disorders

Convulsions

Diabetes

Prone to High Fevers

Hay Fever

Asthma

Allergic Reaction to Insect Stings

None

Please provide details on any of the items listed above, and what type of allergic reactions are common.

Does your child require regular medication?

Date of last tetanus (DpT) immunization

MM

DD

YYYY

Disabilities or chronic recurring illness:

Other medical issues we should know about.

Medical Providers

Medical Insurance is required to attend Faith Adventure Camp. Parents will be held responsible for the cost of any necessary medical treatment due to illness or injury. Who is your medical insurance carrier?

Group number:

Family Physician or Pediatrician name:

First Name

Last Name

Physician's phone number:

After submitting the Medical Information form, please email your camper's immunization record and a copy of both sides of your insurance card to faithadventurecamp@gmail.com, or text these items to 602.206.7382. If your child is not immunized, please download a copy of the "Immunization Waiver Form" by pushing the blue button at the bottom of this section. Your application will not be considered complete until we receive this documentation. Please use this space to provide any pertinent medical information not yet covered on this form.

PLEASE NOTE: YOUR APPLICATION WILL NOT BE CONSIDERED COMPLETE UNTIL WE RECEIVE ALL OF THE DOCUMENTATION OUTLINED ABOVE. Please call or text 602.206.7382 with any questions.

Dietary Restrictions Form

This form is intended for SPECIFIC FOOD ALLERGIES, not for general food preferences. For the safety and well-being of your child, please be as specific as possible.

While we can make slight adjustments to our current menu, we cannot substitute food items already planned. If your child requires special food, it is the parent’s responsibility to provide that food.

Please contact Paula Carruth @ 480-558-6469 or email paula7@descopm.com, to discuss your camper’s special circumstances prior to June 15th.

Camper Name

First Name

Last Name

My child has special dietary needs

Please list any MEDICAL DIETARY RESTRICTIONS that your child has:

Person to contact regarding questions about dietary restrictions:

First Name

Last Name

Phone

(###)

###

####

Email

Medical Treatment Authorization / OTC Medication Authorization

Camper Name

First Name

Last Name

EMERGENCY AUTHORIZATION: I hereby give permission to the medical personnel selected by the Camp Director to order x-rays, tests, and treatment for my child or myself. In the event that I cannot be reached to authorize treatment 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 or myself. This form may be photocopied for use out of camp.

CAMP NURSE TREATMENT AUTHORIZATION: I authorize permission for the Registered Nurse and Faith Adventure Camp to give over-the-counter medications on standards of practice: Tylenol, Ibuprofen, Benadryl, Phenylephrine/Gualfenesin (cold/cough), Pepto-Bismol, Tums, and topical medications, as well as all medications listed on the Medication Dosing Schedule.

Parent or Guardian Name

First Name

Last Name

Date

MM

DD

YYYY

CAMPER ACTIVITY RELEASE AND SIGN-OUT AUTHORIZATION

While there is trained staff supervision at all times, there are many inherent risks in activities and games that campers are involved in. Most activities are conducted outdoors where there is a possibility of risk or physical injury or harm. I voluntarily choose to allow my child to participate in the camp experience and assume the risk of injury or harm that could result from participation.

On my own behalf and that of my personal representative and heirs, I hereby release Faith Adventure Camp, Mountain Meadow Ranch, and the Board of Directors and Volunteers of Faith Adventure Camp of all liability resulting from any injury or harm while my child participates in any activity with Faith Adventure Camp. My child has permission to attend camp, participate in all activities on or off the camp site under the supervision of the camp staff, and receive emergency medical care if necessary.

Camper Name

First Name

Last Name

My child may participate

Activity Restrictions

IMPORTANT! Please list the names and cell phone numbers of all persons, parents included, who are authorized to sign your child out at the end of camp. Only adults with proper ID may sign out a camper.

Parent or Legal Guardian Signature

First Name

Last Name

MEDIA RELEASE

I hereby grant, voluntarily and with full understanding and no expectation of monetary remuneration, Mountain Meadows Ranch Bible Camp, Inc, and Faith Adventure Camp, a license to do the following:

Use and storage of my name and image, by means of digital or film photography, video recording, audio recording, or other documentation, with respect to the activities at Mountain Meadows Ranch Bible Camp or Faith Adventure Camp.
Use of any stored data including my name and image in printed and electronic publications of Mountain Meadows Ranch Bible Camp or Faith Adventure Camp.
Use of any stored data including my name and image for use in various forms of digital media, including but not limited to, websites, social media channels, email campaigns, and YouTube and other video channels, for the purpose of benefiting and promoting Mountain Meadows Ranch Bible Camp or Faith Adventure Camp.
If I am signing this agreement on behalf of a minor child, I hereby warrant that I am the legal parent or guardian of the child listed below and that I have the legal authority to sign this agreement on behalf of the child.

Camper/Staff Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date

MM

DD

YYYY

Signature of Parent or Guardian indicates agreement with the Media Release above

First Name

Last Name

FAC DISCIPLINE POLICY

At Faith Adventure Camp, we strive to provide a fun and safe learning environment. In order to maintain this, we stress the importance of respect for other campers, staff and property. For the benefit of all campers, it is important that children behave appropriately. To ensure this quality and safety each camper must follow the program rules below. If it becomes necessary to take disciplinary action against a camper (or staff), the steps outlined below will be followed. We reserve the right to bypass one or more steps in the process if a situation warrants.

FAITH ADVENTURE CAMP PROGRAM RULES AND REGULATIONS

My child will show respect to all campers, staff, equipment and property.
My child will use appropriate language and treat others according to the Golden Rule of treating others they way they want to be treated.
My child w1ll listen to and follow instructions given to him or her by their Counselor, Activity Leaders, and Camp Director.
My child will maintain a positive attitude and do his or her best to have a fun camp experience.
I understand that if my child persists in continually disruptive behavior, I may be called to pick up my child from camp early at my expense and with no refund of camp fees.

DISCIPLINE POLICY AND PROCEDURES

1st Incident: The camper will receive a verbal warning and an explanation as to why the behavior is inappropriate (whenever possible, this will be done in a one-on-one setting, removed from other campers).
2nd Incident: Staff will determine an appropriate consequence for the camper's actions (examples may include a "time out" or exclusion from participating in an activity). The Camp Director will notify the camper's parent/guardian by phone of his/ her child's behavior.
3rd Incident: The child will be immediately excused from all camp activities and the parent/guardian will be required to pick up his/her child from camp in a timely manner as determined by the Camp Director.

Transportation from camp is the sole responsibility of the camper's parent/guardian. There will be NO TUITION REFUND for campers expelled from camp due to behavior issues.

Faith Adventure Camp reserves the right to expel any child for a first or second incident in cases of serious behavior problems.

The form below allows you to enter up to three campers with one parent or legal guardian signature. By signing below I hereby acknowledge that we have read aloud and discussed this discipline policy and each person understands and agrees to abide by its terms and conditions.

Camper Name #1

First Name

Last Name

Camper Name #2

First Name

Last Name

Camper Name #3

First Name

Last Name

Parent or Legal Guardian Signature indicates agreement with the Discipline Policy above

First Name

Last Name

Date

MM

DD

YYYY

MEDICATION DOSING SCHEDULE

If your child requires daily medication, please download the dosing form by pushing the blue button below. Fill it out and email it to faithadventurecamp@gmail.com along with your child’s immunization record and your insurance card. Please bring the medications listed on this form to camp with you in their original container with your child’s name clearly showing on the container. These forms can be scanned and emailed to milo.frazier@gmail.com as well.

Name

First Name

Last Name

Email

Subject

Message

MEDICAL DOSING fORM

IMMUNIZATION WAIVER FORM

PAY $360.50 CAMP FEE NOW

You may also pay by check in the amount of $350. See the Registration and Payments section on the PARENTS page of this site for details.