EmailMe Form - Grace Point Camp 2018

Camper Information

Which session(s) are you attending?

***PLEASE NOTE that FEMALE camper spots for Junior Summer Session (July 8th-13th) are no longer available. All female applications submitted will be waitlisted.

***PLEASE NOTE that FEMALE camper spots for Intermediate Summer Session (July 16th-21st) are no longer available. All female applications submitted will be waitlisted.

Family Camp (May 25th-28th) *please register ALL attending family members*

Junior Camp (May 31st - June 5th)

Adult Camp (June 7th- 10th)

Jim Muir Kamp 4 Kids (June 13th - 16th)

Intermediate Camp (June 19th-24th)

Youth Camp (June 27th - July 2nd)

Junior Summer Session (July 8th - 13th)

Youth Summer Session (July 24th - 29th)

Name *

First Last

Date of Birth *

MM / DD / YYYY

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Gender *

Email

Phone

### - ### - ####

Grade (Fall 2018) *

Home Parish

Denomination (if other than Episcopal)

Please list dietary restrictions here

Parent/Guardian Information

Name *

First Last

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone *

### - ### - ####

Email *

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone

### - ### - ####

Email

Additional Emergency Contacts

Name *

First Last

Phone *

### - ### - ####

Relationship to camper *

Name *

First Last

Phone *

### - ### - ####

Relationship to camper *

Community Covenant

By joining the intentional community of Grace Point Camps, all participants and staff agree to maintain a healthy, mutually-affirming environment.
Under this agreement, it is not acceptable for participants of Grace Point Camps, an ANY time, to:
 Drink, posses, or be under the influence of alcoholic beverages;
 Possess or be under the influence of illegal drugs;
 Possess or be under the influence of any controlled substances not directly prescribed by a physician;
 Smoke, use, or possess tobacco;
 Show disrespect (including use of coarse language or jokes that may offend) to fellow participants, staff, property of others, or property of Grace Point;
 Engage in any inappropriate sexual conduct, contact, or behavior;
 Possess or use weapons of ANY sort;
 Commit acts of theft or violence;
 Leave the established boundaries without permission of the staff;
 Or fail to remain with the group during activities.

Technology Agreement

Technology is part of our every-day lives and can be both beneficial and distracting. By choosing to join summer camp in a Christian Community, it is expected that each participant is willing to leave certain technological comforts behind so as not to be distracted from the larger community. Participants are therefore NOT PERMITTED to bring cell phones, PDAs, or other mobile communication devices; laptops, iPads, or other tablet computers; handheld video game systems or DVD/Blu-Ray players; or any other electronic device that is not medically necessary.
Should these items appear the Summer Staff, operating under the Executive Director, reserve the right to confiscate the device. Any electronic device taken up will be returned at the conclusion of the camp session.
I have read the Community Covenant and Technology Agreement, and I agree to abide by them throughout the entire camp session. I understand that failure to adhere to this covenant may result in my being dismissed from the camp session, and registration fees will not be refunded. In the event of my dismissal, I understand that I or my parents/guardians will be responsible for my transportation home.

Signature *

Clear

Date *

MM / DD / YYYY

Camper Medical Information and Release

Please be aware that all medical information listed below is to be kept confidential, and is only used by camp staff in order to provide necessary care.

Camper Full Name *

Name of Insured *

Carrier *

Group Number *

Policy Number *

Carrier Contact Number *

### - ### - ####

Is the camper allergic to any medications, prescriptions or over the counter? If yes, please list. *

Does the camper have a history of illness or injury of which the camp medic should be aware? If yes, please explain. *

Does the camper have any food allergies? Please list severity. *

Does the camper have any behavioral concerns of which the staff should be aware? Please explain. *

Does the camper have a history of bed wetting? *

Yes

No

Can the camper swim? *

Yes

No

Please list all medications that the camper will be bringing to camp. Please include the names and doses of each, including regular daily medication times (or "PRN" if as needed) *

Liability, Medical and Image Release

To be signed by parent/guardian.

I authorize Grace Point Camp, if necessary, to seek emergency medical help to be administered by a licensed physician and to use the medical information above in doing so. I accept the standard liability insurance provided by the diocese and I release the Diocese of East Tennessee from all liability beyond this coverage.
I have read the Community Covenant and Technology Agreement and I understand that a particular standard of behavior is asked of all participants, and that by signing the covenant, my child agrees to abide by that standard. I understand that any violation of the Community Covenant may warrant disciplinary action by the Summer Staff and may include expulsion from the camp session(s). Should my child be dismissed from camp, I assume all financial responsibility for transportation home.
I understand that Grace Point Camp and the Diocese of East Tennessee record photographs and videos at all events and that these images may appear in Diocesan publications or on the Diocesan websites. Some photographs may be identified by name. In releasing the Diocese to use my child’s image, I waive all rights for compensation and release the Diocese to use these images as deemed necessary for the promotion of summer camp ministry in the Church.

I authorize my child (listed below) to attend Grace Point Camp in 2018. *

First Last

I authorize the Episcopal Diocese of East Tennessee to record and publish my child's image. *

Yes

No

Signature *

Clear

Payment Information

To be signed by parent/guardian.

***I understand the cost for attending Grace Point Camp, to be paid upon arrival in the form of cash or check. Cost of sessions are listed below.***

May 25th - 28th Family Camp $310 includes 1 child & 1 adult

May 31st - June 5th Junior Camp Rising 4th-6th grades. $415 per camper

June 7th-10th Adult Camp Adults 21 and up. $225 per camper

June 13th - 16th Jim Muir Kamp 4 Kids Outreach Camp

June 19th - 24th Intermediate Camp Rising 7th-9th grades. $415 per camper

June 27th - July 2nd Youth Camp Rising 10th grade-rising college freshmen. $415 per camper

July 8th - 13th Junior Summer Session Rising 4th-6th grades. $415 per camper

July 16th - 21st Intermediate Summer Session Rising 7th-9th grades. $415 per camper

July 24th - 29th Youth Summer Session Rising 10th grade-rising college freshmen. $415 per camper

Scholarships

The Camp Billy Johnson scholarship is available for any camper in need of financial aid. If you are interested in the CBJ scholarship, please fill out the following form. Questions? Email Executive Director Brad Jones at bjones@gracepointcamp.org.

I wish to apply for the Camp Billy Johnson Scholarship

Yes

Amount requested

Signature *

Clear