CENTRIKID Camp Info. copy

2016
Group
Leader
information
Campbellsville University
contact info
Director:
Isaac Kierstead
Assistant Director: Sara Wilson
Camp Cell:
615.657.9252
Camp Email:
centrikid2@gmail.com
(You will send your participant list to this email address at least 2
weeks before camp starts.)
Your director or assistant director will email you your housing specifics.
If you haven’t heard from us 5 days before camp...or if we’ve been playing
phone tag... please email us at centrikid2@gmail.com
Housing
Housing is dorm style for boys and girls (2/room) with bath on hall. One of
the boys’ dorms is a little different, with 4 individual bedrooms with a shared
bathroom. All beds will be twin size. There are some situations where there
may be 3/room. If this is the case, you will be aware of this before your arrival
at camp.
Towels and linens are NOT provided. You might want to bring hand
soap, paper towels, shower shoes, and a bathmat.
Housing will be determined when we have received participant lists for
the churches attending camp for the week. Please make sure to send in
your participant grid 2-3 weeks before camp!
letters from home
ATTN: CentriKid Camps
Camper / Church Name
1 University Dr
UPO 883
Campbellsville, KY 42718
Make sure you send all mail by Day 2 of camp, so that it gets to camp before
your camper leaves!
campus information
Website:
www.campbellsville.edu/
Time Zone:
Eastern
During Check-In, you will receive keys to the rooms you’ll stay in for the
week of camp. If keys are lost, they are $25 to replace.
Weird Science
track time
Archery
wet & wild Sign Language
no boys allowed
track times
descriptions
• Archery - Learn how to shoot a bow & arrow and even practice on our foam targets
Splish Splash
track
• Art Studio - A combination of painting, sculpting, & crafting
• Baseball - Learn various skills, drills, & games of baseball
Adventure
• Basketball - Learn various skills, drills & games of basketball
cheernastics
build it Tennis
• Build it - Creative hands-on building activities
• Cheernastics - A combination of cheerleading & gymnastics
times
• Drama - Learn what it means to be an actor and perform various skits
• Flag Football - Learn various skills, drills & games of football
• Creative Dance - Learn a creative movement and perform in front of camp
Outdoor games
• Kitchen Chaos - Cook and create fun foods from various ingredients
• No Boys Allowed - A girls only track where you discuss specific “girl” topics
Baseball Tell the
Flag Football
• Outdoor Games - Play some favorites like wiffleball, capture the flag, & ultimate Frisbee
World
volleyball track times track times track times track times
• Sign Language - Learn the basics and performing a song through Sign Language
• Soccer - Learn various skills, drills, & games of soccer
• Softball - Learn various skills, drills, & games of softball!
New
Trac
k!
• Splish Splash - Fun and crazy games in the pool
• Tell the World- Learn about missions and how you can play a part in Jesus’ mission
Kitchen Chaos
soccer art studio
• Tennis - Learn various skills, drills of tennis
• Volleyball - Learn various skills, drill of volleyball
Creative Dance
Blast
• Weird Science - Fun experimental games & activities with safe ingredients
• Wet & Wild - An assortment of games involving water hoses, water balloons, etc
* Tracks are subject to availability. Make sure campers know the sports tracks are for beginner to intermediate players. We will be
teaching basic skills for each sport, so if you have an all-star, you might want to encourage them to try something new!
Archery
Art Studio
Baseball
Basketball
Build it
Cheernastics
Drama
Flag Football
Creative Dance
Kitchen Chaos
No Boys Allowed
Outdoor Games
Sign Language
Soccer
Softball
Splish Splash
Tell the World
Tennis
Volleyball
Weird Science
Wet & Wild
Archery
Art Studio
Baseball
Basketball
Build it
Cheernastics
Drama
Flag Football
Creative Dance
Kitchen Chaos
No Boys Allowed
Outdoor Games
Sign Language
Soccer
Softball
Splish Splash
Tell the World
Tennis
Volleyball
Weird Science
Wet & Wild
CAMBELLSVILLE
University Map
The village
2
The village
1
b. study
rooms
outdoor tracks
volleyball
archery
8
druien
hall 9
powell athletic
center
basketball/pool
tennis
north
hall
stapp
hall
3
4
REC FIELD
winters
dining hall
(cafe)
davenport
15
student
commons
Check In
Books
N’
Beans
7
14
The Spot
Indoor
practice
field
Student activity
center
10
cheernastics
Wet and wild
track
FOOTball field
football/soccer
track times
Baseball
7
Housing
Chik-fil-a
Alumni
building
b. study
11
carter
rooms
Science
Hall
building
b. study
b. study
rooms
rooms
ransdell
chapel
South hall 5
audi/ camp store
east
South hall
west
Men’s Village
13
12
6
16
Buildings to know
indoor practice field
11
science building
15
winters dining hall
powell athletic center
12
carter hall
16
ransdell chapel
9
druien hall
13
alumni building
10
student activity center
14
davenport student commons
1
The Village
5
South hall east
7
2
the village
6
south hall west
8
10
3
North Hall
7
Men’s Village
4
stapp Hall
Campbellsville University is a small campus in a quiet town. Our contacts at CU are the best of the best and
will do whatever it takes to meet your needs, normally before you even know you need something.
As soon as you enter campus, you will see CentriKid flags and staff in matching blue shirts pointing you to
where you will need to go for Check-In.
What to eat & where to hang out
Wifi is available campus wide. There will be an area that will have coffee and internet access all day for adults to stop in and
hang out with each other, check email, and just have a few quiet moments away from the craziness of camp. You also will get a
really great map/camp guide when you arrive on campus for Check-In! All the facilities that we get to use at Campbellsville are
great. The rec field is conveniently in the center of campus and all classroom space is close. We will be the only large camp on
campus throughout the summer!
The Davenport Student Commons houses a Starbucks and a computer area that can be utilized by leaders to check email, etc.
There also is a campus bookstore in that building that sells drinks, candy, and other items that campers can take advantage of
during hang time. There is a Chick-fil-A on campus that is a big hit!
SCHEDULE
DAY 1
1-4 pm
_______
7 pm
7:45 pm
9 pm
10 pm
10:30 pm
Check-In
Dinner
Opening Celebration
Team Time / Adult Gathering
Church Group Time
Head to Room
Lights Out
Day 2 - 4
7 am
8:30 am
9 am
11 am
12:15 pm
1:30 pm
2:30 pm
3:30 pm
Breakfast/Time Alone With God
I Can’t Wait
Team Time (Bible Study / Rec)
Lunch
Team Time (Bible study/Party)
Track A
the
Track B
Spot
Track C
*OMC replaces Party on Day 4
4:30 pm
_______
7 pm
8 pm
10 pm
10:30 pm
Day 5
7 am
8:30 am
8:45 am
9:30 am
10:15 am
Hang Time
Dinner
Worship
Church Group Time
Head to Room
Lights Out
Breakfast / Time Alone With God
the
Team Time
Spot
Adult Gathering
Closing Celebration
Churches Depart
Day 4 Afternoon
12:15 pm
1:15 pm
2:15 pm
3:15 pm
3:50 pm
5 pm
Bible
Track A
the
Track B Spot
Track C
Team Time ( Bible study & OMC prep)
OMC
Hang Time
close toed Shoes
the
Spot
Meetat theSpot
wear your color
entering & completed
3rd=Yellow
completed
4th=Green
completed
5th=Blue
completed
6th=Red
Adult=Orange
Encourage your campers to wear their color to OMC.
Their grade is the one they just completed.
They will want to have a shirt that is their color for OMC!
They can be purchased in the store or they can bring
one from home.
Schedule Note:
Everyone has loved having smaller groups in Bible study (12-15 avg.), and the second Bible study time in the afternoon provides a
perfect opportunity to reinforce the lesson and make meaningful life applications. Because the group size in the Party is smaller too,
more kids from each church participated in stage games. Moving to 3 track times allows more kids to participate in the tracks that they
wanted, and to stay engaged throughout the day.
After taking your feedback, we moved Track Times to directly after Lunch and it worked great last summer. It gives kids more time to
digest their lunch before going outside and also gives them more time to change into a bathing suit or the correct shoes for their track.
On Day 4 we will run a slightly altered schedule in the afternoon to accommodate for OMC, but your Camp Director will
handle all the details to make this happen.
To Do
before camp
May 1: Cancellation
Deadline
All cancellations after May 1 will incur an
additional $50.00 fee for each person dropped.
When this occurs, deposits cannot be applied
toward your balance, so make any changes
before May 1.
Meet with Parents
Register for camp!
recruit sponsors
Bring 1 male sponsor for every 5 male campers
and 1 female sponsor for every 5 female
campers. You may bring students to be in the
Team Assistant Program (see page 9). The
cost is the same for Team Assistants as other
participants.
All sponsors must:
» Be at least 18 years old(unless part of the
Team Assistant Program)
» Have completed background check
» Help enforce curfew and clean up of your
group’s housing
» Monitor dress code of your campers
» Encourage participation and promptness
as well as set a great example for the kids
FEbruary 15:
$50 deposit due
A $50 deposit for each reservation is required.
All deposits are non-refundable and cannot
be applied toward the balance due. Many
churches collect monthly payments for camp
from their parents, do fundraisers to cut costs,
and have sponsorships through their church
to help aid parents. Fundraising normally
begins even before this deposit deadline. Many
churches require the $50 deposit from parents
when they sign their children up to go to camp.
Email us
special needs
Email any needs that we should be aware of
prior to camp to centrikid@lifeway.com. Please
specify if it is a mobility, dietary, housing,
or emotional/spiritual need. This could be
anything that may affect housing or cafeteria
needs. Please include the week and location
that you will be attending camp. If you
need a refrigerator for medication or any
other form of special accomodations, let
us know and we will do our best to make
arrangements for you ahead of time
» Have them bring a copy of their insurance
cards (front & back) and the completed
release form.
» Have a notary at your meeting so that
release forms can be notarized. Only one
form needs to be notarized, but you will
want to bring a copy of that form with
you (just copy them all after they are
notarized). You will turn in the orginals to
CentriKid during Check-In and will keep
the copy. Make sure every participant has
one, even sponsors.
» Share your plan for traveling to camp
and returning home. Include lunch plans,
times to drop off/pick up their camper,
etc.
» Share camp address for letters from home
(found on page 3).
» Collect photo and DVD orders ($6/group
pic, $30/End of the Week DVD). There is a
form for parents to fill out on page 15.
» Pass out and go over the Parent Packet
(starting on page 13 or found online here)
with parents.
Get all release
forms notarized
and copied Sign
statement of
compliance
After background checking all of the adult
sponsors that you will bring with you, please
sign the Statement of Compliance in this
packet and bring it with you to
Check-In at camp.
complete any
needed special
attention cards
We take special attention cards very seriously at
camp. Any mobility, dietary, emotional/spiritual,
or medical need that camp staff need to know
about should be written on these cards and
turned in during Check-In. Also, fill out a card
for any camper who will have a birthday while
at camp.
To d0...
at least 3 weeks before
camp: Pay Balance
Final balance must be received 14 days prior to arrival at camp.
If it is not, your group will be charged a one-time $75 late fee.
Call us at 1-877-CAMP123 about auto-pay options for LifeWay
accounts or to put your balance on a credit card.
» Your male/female counts are locked in 3 weeks prior to
camp. At this point, we will begin housing assignments
and final preparation for your arrival. After this point,
you may substitute individual campers, as long as male/
female counts remain the same. Please notify us of any
last minute changes via our camp email or
Participant
camp phone.
List
no later than 3 weeks
before camp: Email your
participant list
Email your participant list (download here) to our camp email
address (page 3). We can’t do housing until we receive this. Be
sure to include correct male and female numbers (including
sponsors) and let us know if there are specific campers who do
or do not need to be in the same Bible study group.
Prepare Your forms
Turn in at Check-In (in this order):
» Notarized Release Form (for campers and adults -- found
in Parent Packet)
» Track Time Cards
» Statement of Compliance
» Group Order Summary
Keep:
» Copy of Notarized Release Form
prepare, pack, and meet us
at camp!
We can’t wait to see you! Be sure to take pictures of your
campers having fun at camp and post them online or email
them to parents, so they can get in on the fun their kids are
having at CentriKid! Let us know if there are any questions we
can answer for you!
Camp Nurse
Camp Nurse
form
You can bring a certified RN or doctor with your group.
Their spot is free. We only need one nurse per cycle of
camp so sign up now! Check out for more information.
Centrikid
Policies
Travel and Compliance
Your church group is responsible for checking into the
background of adult sponsors and signing the
“Statement of Compliance” in this document. Remember to
have the church’s insurance and needed info for travel. The
church is liable on the way to and from camp.
Campers without
personal insurance
If a camper requires medical attention while at camp, the
camper is responsible for the cost. If the camper does not
have insurance, the sponsoring church will be the financially
responsible party. If the medical attention is needed because
of an accidental injury at camp, LifeWay provides a limited
insurance policy that applies to those costs.
Damages and keys
Your church group is responsible to pay for damages to any
facilites or Residence hall caused by your group. Normally,
church groups are given two keys/room. Check out the location
specifics page for how much lost keys cost at your location.
Cell phones at camp
Please have campers leave phones at home or turn them in so
that the group leader can employ a check-out system, during
meals, during hang time, and during the time between church
group time and lights out each night. Cell phones will not be
allowed at any other time for campers.
Illnesses at camp
Please do not bring campers with a fever or who are sick to
camp. CentriKid Camps will work with church group leaders to
handle cases of illness at camp on a case-by-case basis. We must
ask that campers displaying flu-like symptoms be sent home for
the safety of remaining campers.
Bringing your own
kids to camp
Your kids, younger than the 3rd grade, are welcome to join
their parent during programming since they are not allowed
to participate in team time or tracks. If they need bed space
and meals, the cost is full price. If they need no bed space or
meals, there is no charge. Rising 3rd graders are welcomed
to participate in normal camper activities at the discretion of
group leaders and parents.
parent
meetinghelp
When should you
have a meeting?
Every group is different. You will probably want
to have one around sign up time to promote and
answer any questions that parents may have. You
will definitely want to have one about two weeks
before camp, covering the parent packet and
getting forms turned in and notarized. You may
feel the need to meet with parents somewhere in
between those as well.
Subjects you
will want to
talk about:
Logistics
Let them know what time to be at the church
to leave and what time you’ll be back. Are you
stopping for any meals on the way to camp or
the way back? (You may want to take up money
from parents for this meal. Each child can have an
envelope for their travel meals so they don’t have
to worry about saving enough of their camp
spending money.)
Parent Packet
Walk through the parent packet with parents.
Tell them about the camp schedule and what
color team their camper will be. Remind them to
pack a shirt of the camper’s team color for OMC
or to send money to purchase a t-shirt at the
Camp Store. Share the packing list [make sure
to include what type of bedding they need to
bring, and don’t let them forget to bring towels!]
Also, remind them to write their child’s name
on everything! Talk them through how they can
begin to pray for and with their kids who are
attending camp and how they can start talking to
their child about the training of our faith.
track time info
Remember that campers fill out track time cards
before you get to camp. It will be a good idea to
pass out the descriptions on pg 4 to parents, so
they can help explain the tracks. You can have
the campers fill out track time cards on the bus as
you’re going to camp, or whenever you choose.
Check grades
Take this time to double check with the parents
which grades their children have just completed.
We want to have the campers in the correct Bible
study grade when they get to camp.
Contact at Camp
Give them your cell phone number, and also
let them know your policy on cell phones and
when they could call. There’s time in the schedule
during our afternoon and evening hang time
they coud use to call. Give parents the address at
camp.
collect store orders
Take up money for any group pictures, DVDs,
Camper Care Packages, and Camp Store Cards.
» Group pictures [$6] - serious or funny
Picture Orders are due on the First Night
of Camp
» DVDs [$30] - includes all media show
that week can be ordered before Day 5
of camp
» Camper Care Packages [$30] - includes
all team specific items to get campers
completely prepared for OMC. More
information on page 14. Must be preordered by June 1st
» Camp Store Cards - available in increments
of $5, $25, & $50.
In the parent pack, there is a form that parents
can fill out to indicate what they would like to
purchase ahead of time [group pictures, DVDs,
Camper Care Packages, and Camp Store Cards].
After you receive these forms from them, you
will need to fill out this preorder form
for the Camper Care Packages and Camp Store
Cards. This will help us make sure we have
exactly what you need when you get to camp!
The preorder form must be filled out before June
1st. If you miss this deadline, contact your camp
director or email centrikid@lifeway.com
Paperwork
Ask a notary to attend your meeting and notarize
release forms after parents fill them out. Make a
copy of each form before coming to camp. You’ll
turn in the original and keep the copy.
Guests at CentriKid
To ensure the safety of all of the campers,
everyone must follow this checklist:
» At the beginning of the week, inform your
Camp Director of any visitors who will be
arriving at camp. This is for both safety of
the campers and availability of space.
» Upon arrival, guests must call the camp
cell phone number to arrange a meeting
location to receive their visitor sticker and
to sign in. The Director’s number can be
found on page 3 of this document.
» Camp Director/Assistant Director can point
the visitors in the direction of their church
group at that time or arrange a meeting
with their church group’s leader.
follow-up
after camp
The church van just rolled into the parking lot after a week of
fun and ministry at CentriKid. Now what? Everyone knows that
follow-up is important and we need to continue to connect
with our kids after camp. However, often after the luggage is
unpacked, the intentionality of camp can tend to fade into the
background. How do you get your leader to grasp the reality
of what they lose by simply marking camp as “done” on the
calendar? Just one more hour could make a difference for your
church and for the Kingdom!
Follow-up after camp is something we’ve learned that churches
sometimes overlook, so we put together some practical tips to
get you started. We generally see three levels of follow-up and
some specific actions that are important in each level:
1: New Decisions
Any camper who made a decision to follow Jesus or started
asking questions about their faith needs follow-up. Even kids who
have a supportive Christian family can struggle with what to do
next. It’s important to follow up with them in person and as soon
as possible. This is a very pivotal time in their life.
Meet with their family and take a copy of page 17
“Questions for Dig Deeper” in the Parent Packet with you.
Let them know their child came home with a CentriKid
Devotional book that includes four weeks of devotions
that we hope will encourage the camper to grow in their
faith and really learn what it means to spend time alone
with God. Use the questions from camp in the Parent
Packet, put the list on the refrigerator, and talk about
them often.
Write a hand-written note to the camper encouraging
their decision or questions.
Connect that kid to a teacher or small group leader for
their age group.
Plug them into other discipleship opportunities at your
church, so they can make friends, get involved, and
begin to grow spiritually.
If possible, talk one-on-one with the kid every few weeks
to encourage their decision/lifestyle.
2: Guests and Friends
You may have brought kids who are visitors to your church and
haven’t really gotten plugged into the children’s ministry. You also
may have brought friends of kids in your ministry who attend a
different church or maybe don’t regularly attend any church. You
can be the person to make them feel welcome and included and
make sure the things they learned at camp don’t fall through the
cracks when they get home.
Write a hand-written note to the camper to say thanks
for coming and remind them that God is always with
them, just like we learned at camp.
Write a hand-written note to the parent. Include page17
“Questions to Dig Deeper” and let them know their child
came home with a CentriKid Devotional book. Offer to
visit or call to connect with them.
Revisit your list of campers in two months...follow up
with a note or call to those who have stopped coming.
3: regular attenders
Kids who are regular attenders at your church are also in need
of follow-up. Even if they are already following Christ, they need
someone to come alongside them and teach them what it means
to live their lives for Christ. Discipleship is such a huge part of their
journey with the Lord and can be overlooked when all of the
focus is on new attenders.
Write a hand-written note to the camper to say thanks
for coming and reinforce something from the week.
Write a hand-written note to the parent. Include the
“Questions to Dig Deeper” on page 16, let them know
their child came home with a CentriKid Devotional book,
and to thank them for their support.
Some tips on follow-up
Some churches will assign a group of campers to each Adult
Sponsor. It works well with our 1 to 5 camper/adult ratio
requirement. Using this model, one adult is responsible for
following up with each of their specific 5 kids, regardless of the
level they are on.
You may also want to divide up your group and have a certain
adult who does all of the Level 1 follow-up, another who does all
of Level 2, etc. Use the model that works best for your group.
team assistantprogram
What is it anyway?
The Team Assistant Program is an option designed to give your most-trusted high school rising
juniors and seniors or young college students a behind-the-scenes look at being a camp staffer
while they act as a sponsor for your church group. In general, each church that participates brings
two Team Assistants, but the number of TA’s brought is ultimately left to the church group leader’s
discretion. Middle school students and high schoolers who are not at least rising juniors may
not participate.
What Will they do?
•
•
•
•
•
Count toward your 1:5 adult to camper ratio and stay with your group.
Attend staff meetings each morning to prepare for the day.
Shadow a Team Leader (camp staffer) during the morning at Recreation.
Help out with tracks in the afternoon.
Get a good idea of what serving on camp staff is like, in case they want to apply one day.
How do i sign them up?
Register them just as any other camper or adult sponsor. Remember, they must be at least a rising
junior or older. Identify them as “Team Assistant” on the Participant List that you turn in two weeks
prior to camp.
SPECIAL NOTES:
Night 1 - Attend welcome meeting with your rec leader during adult gathering. Rec leader will go
over talking points and let team assistants know their assignments for the week.
Day 4 - Tracks take place at 12:15, 1:15, 2:15pm. At 3:15, team assistants should assist with OMC setup.
During OMC, team assistants can help create energy and excitement!
Day 5 - Eat breakfast with recreation leader if possible. Meet with recreation leader at 8:45am during
the final adult gathering.
Day 2-4
TIME
ACTIVITY
7:40am
Morning Staff Mtg
8:30am
I Can’t Wait
9:00am
Recreation
10:50am
Rec Ends
_______
12:15pm
Lunch
PM Bible Study
1:30pm
2:30pm
3:30pm
4:30pm
_______
7:00pm
8:00pm
8:45pm
10:00pm
Track A
Track B
Track C
Hang Time
Dinner
Worship
Church Group
Evening HT
Head to room
ASSIGNMENTS
Regular attendance required
Time Alone with God, Schedule
Greet kids, create energy, etc
sit with church
With assigned rec staffer:
refill coolers, assist rec leader
Help clean up rec, help set up
SPOT & track times
Eat with church group
Assigned Bible Study staffer,
Assist & participate in activities
Assistant Track Leader
Assistant Track Leader
Assistant Track Leader
With Church Group
With Church Group
With Church Group
With Church Group
With Church Group
With Church Group
Group Order Summary
turn this in at check in
Church
Group
Photo
(
$6)
how many of each?
__
__
serious
funny
End of Week Dvd ($30)
__how many?
Camp Store Cards
__$5
__$25
Total
Camper Care Packages:
pre-order by June 1st
__$50
Be sure to Pre-Order all Camper
Care Packages by June 1st. Click
here to find the Order Form
Yellow
Green
Blue
Red
______________________________________________
__
__
__
__
__
__
__
Y-Medium
Y-Large
Small
Medium
Large
X-Large
2X-Large
__
__
__
__
__
__
__
Y-Medium
Y-Large
Small
Medium
Large
X-Large
2X-Large
__
__
__
__
__
__
__
Y-Medium
Y-Large
Small
Medium
Large
X-Large
2X-Large
__
__
__
__
__
__
__
Y-Medium
Y-Large
Small
Medium
Large
X-Large
2X-Large
Church Name:_______________________________________
Address:___________________________________________
City:__________________________ ST:______ Zip:_________
Email:_____________________________________________
Phone:_____________________________________________
41&$*"-"55&/5*0/$"3%
41&$*"-"55&/5*0/$"3%
Camper Name: ________________________ Grade: _____
Church: ____________________________________
Camp Dates: __________________________________
This card completed by: ______________________________
Camper Name: ________________________ Grade: _____
Church: ____________________________________
Camp Dates: __________________________________
This card completed by: ______________________________
This camper has a need that CentriKid should be aware of:
This camper has a need that CentriKid should be aware of:
Q dietary Q medical Q mobility
Q emotional/spiritual
Q dietary Q medical Q mobility
Q emotional/spiritual
Concerns: _______________________________
Concerns: _______________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
Turn completed cards in to the Camp Director
or Assistant Director.
Turn completed cards in to the Camp Director
or Assistant Director.
41&$*"-"55&/5*0/$"3%
41&$*"-"55&/5*0/$"3%
Camper Name: ________________________ Grade: _____
Church: ____________________________________
Camp Dates: __________________________________
This card completed by: ______________________________
Camper Name: ________________________ Grade: _____
Church: ____________________________________
Camp Dates: __________________________________
This card completed by: ______________________________
This
This camper has a need that CentriKid should be aware of:
has a need that CentriKid should be aware of:
Q dietary Q medical Q mobility
Q emotional/spiritual
Q dietary Q medical Q mobility
Q emotional/spiritual
Concerns: _______________________________
Concerns: _______________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
Turn completed cards in to the Camp Director
or Assistant Director.
Turn completed cards in to the Camp Director
or Assistant Director.
Page 1 of 2
Rev Oct 2013
Participant Form
Group Leaders: Bring ONE notarized copy of this document to registration and keep a photocopy for yourself
to have with you in case of emergency at camp. YOU MUST attach a photocopy of insurance card (front & back).
Church Information:
CentriKid Venue: ______________________________ Name of Church: _________________________________
Group Leader: __________________________________ Group Leader’s cell # at camp: (_____)_____________
Church Address:_________________________________ City: ___________ ST: ________ ZIP: _____________
Camper’s Info:
Participant Name____________________________________________ Age_______
Date of Birth:___/___/____ Grade Completed (campers only): ______________
Address: ______________________________________City: __________________ ST ________ ZIP__________
In case of an emergency notify:_________________________________
Relationship to participant:_______________________
Phone Numbers - Home: (___)____________________ Work: (___)_______________________
Mobile: (___)____________________ Other:(___)_______________________
Medical Profile
Generally, the participant’s Health is: (Check One)
□Excellent □Good □Fair □Poor
If Fair or Poor, please explain the condition:_________________________________________________
List any medical difficulties which are currently being treated:___________________________________________
Check any of the following that cause you problems & explain:
□ Asthma
□ Sinusitis
□ Bronchitis
□ Kidney Trouble □ Heart Trouble □ Diabetes
□ Dizziness □ Stomach Upset □ Hay Fever
________________________________________________________
________________________________________________________
________________________________________________________
List any medicines or substances to which you are allergic: _________________________________________
List any previous operations or serious illnesses_____________________________________________________
List any medications you are currently taking: ______________________________________________________
List any special diet or special needs:______________________________________________________________
□Other:_____________
Childhood Diseases: □Chickenpox □Measles □Mumps □Whooping Cough
Date of Tetanus Immunization: ___/___/___
You MUST attach a photocopy of insurance card (front & back).
If a camper requires medical attention while at camp, the camper is responsible for the cost. If the camper does not
have insurance the sponsoring church will be the financially responsible party. If the medical attention is needed
because of an accidental injury at camp, LifeWay provides a limited insurance policy that applies to those costs.
Permission, Acknowledgements, Release, Indemnity
My permission is granted for the camp or event director, church official, any camp or event staffer, or adult present or in
charge of first aid, to obtain necessary medical attention in case of sickness or injury to me or my child. Also, I
understand that as a Participant, I or my child may be photographed or videotaped during normal camp or event
activities, and these photos/videos may be used for promotional purposes. I, the undersigned, do hereby verify that the
above information is correct, and I do hereby release and forever discharge LifeWay Christian Resources of the
Southern Baptist Convention, the CentriKid Camp Venue, the Church, camp or event sponsors and state conventions
and their employees (“Released Parties”) from any and all claims, costs, demands, actions or causes of action, past,
present or future arising out of any damage or injury in connection with my or my child’s employment by or participation
in this camp or event. I agree to indemnify the Released Parties for any and all claims, demands, damages, injuries,
costs, suits or causes of action, past, present, or future, arising out of or caused by myself or by my child while
participating in this camp or event or while on property leased or owned by any of the Released Parties.
Assumption of Risk. I am aware of the risks associated with participation in the above event
and do hereby voluntarily assume full responsibility for any risk of loss, property damage or
personal injury, including death, that may result from participation in event activities.
Page 2 of 2
Rev Oct 2013
Recreation– The recreation programs at summer event venues strive to offer fun, safe, and challenging activities that
engage the whole person—body, mind and soul. Program staff are trained and as a team committed to your rewarding
experience with safety as their highest priority. They have done everything possible to mitigate any risks involved in
their recreation programs. However there are inherent risks to participation in recreation activities, including but not
limited to, initiative games, high and low challenge course, outdoor education, paintball and aquatics (not available at
every CentriKid venue). You could experience any of the following – elevated heart and respiratory rates, uncomfortable
group dynamics, climbing or descending unpredictable and possibly slick or uneven terrain, crossing narrow wires and
logs, jumping, running, climbing/descending steep rock faces, traveling long distances in remote settings, carrying
weight on your backs and shoulders, unforeseen forces of nature or weather, any of which could result in injury/illness
that could result in loss of life, limb, and/or property. For more detailed information about the recreation programs
offered at CentriKid Camp Venues, go to www.lifeway.com/centrikid and follow the specific link to the camp venue’s
Group Leader Information.
Understanding. I represent and acknowledge that I have completely read and understand this document and all its
terms and all matters referred to herein, and I signed voluntarily as my free act and deed, that I have had an ample
opportunity to obtain the advice of counsel and that, by signing this document, I understand that I am relinquishing legal
rights and remedies that may have otherwise been available to me. I understand that this Waiver and Release shall be
construed as broadly and inclusively as is permitted by applicable law and agree that if any portion of this document is
held invalid, the remaining shall continue in full force and effect. To the extent the restriction on filing lawsuits is deemed
unlawful, I agree to submit any Claims to a Christian conciliation/mediation organization for binding resolution.
Affirmation. Participant affirms that he/she has not been convicted of nor received a deferred adjudication for: a
misdemeanor or felony under any state or federal statute regarding crimes against persons, sexual offenses, or violent
offenses under the “Participant Name” submitted on this document or any other name or alias.
Copy to Camp Venue. It is understood and agreed that a copy of this form shall be treated as authentic and binding as
the original and that a copy of same shall be provided to camp venue.
Complete and sign below (participants who are minors per your state statute require Parent/Legal Guardian signature).
Participant’s Signature: (only if 19yrs of age or older)
Parent/Guardian Signature:
Date: ___/____/___
Phone: (
)
Date:___/___/___
Notary Acknowledgement:
State of
County of
On __________ before me,
, Notary Public, personally appeared
______________________________________________________________________________ who proved to me on
the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and
acknowledged to me that he/she/they executed the same in his/her/their signature(s) on the instrument the person(s), or
the entity upon behalf of which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the state that the foregoing paragraph is true and correct.
WITNESS my hand and official seal.
Notary signature:
My commission expires:
Statement of Compliance:
This form is turned in upon arrival at camp.
The volunteering Adult Sponsors named below are known to the staff or recognized leadership
of the participating church and the church knows of no reason why any should not serve as a
sponsor for children and youth under the age of eighteen (18). The church confirms that it has
taken reasonable steps to confirm that the individuals are not registered sex offenders by
making inquiries to law enforcement officials or by checking www.nsopr.gov (the National Sex
Offender Public Website). Participating church warrants that it has used
_________________company to perform nationwide criminal background checks on all
Adult Sponsors . Participating church warrants it has brought no Adult Sponsor not listed on
this form.
Names of all Adult Sponsors:
1. _________________
11. _________________
2. _________________
12. _________________
3. _________________
13. _________________
4. _________________
14. _________________
5. _________________
15. _________________
6. _________________
16. _________________
7. _________________
17. _________________
8. _________________
18. _________________
9. _________________
19. _________________
10. _________________
20. _________________
For camps held in Texas, the sponsoring church attests that it has, in addition to the above
referenced sex offender and criminal background checks, satisfied the requirements set forth
by the Texas Department of State Health Services Rule 265.12, which can be found online at
www.dshs.state.tx.us/youthcamp/default.shtm
Church Name: ________________________ Phone #: ___________________
Address: ________________________ City: _______________ ST ____ ZIP _____
________________________
Authorized Representative Signature
_______________
Name Printed
_________
Date
Revised for 2013