Camper

Address

City

State

Zip

Grade Next School Year
10th11th12thGraduate
Birthdate

Age

T-shirt size (adult sizes only)
SMLXLXXLXXXL

What church did you come with? Faith Country Chapel (FCC)

Parent or Guardian

Same address as camper?
YesNo

If not, list
Address

City

State

Zip

Phone Number:
Home PhoneWork PhoneCell Phone

In case of emergency

MEDICAL RELEASE: I, the undersigned am the legal parent and/or guardian of this camper, and I give him/her permission to participate fully in Indian Cave Youth Camp (ICYC) activities unless otherwise noted. I also release FCC & ICYC from all liability while my child is participating in Camp Activities. I give ICYC & FCC leaders permission to obtain, in an emergency, medical or surgical care for him/her in the event I cannot be reached and such is necessary. I understand that every effort will be made to locate me in case of such an emergency. I also acknowledge that I have submitted to FCC a Medical Release & Permission Form (which can be downloaded here) and that there are no updates to that form needed to be made at this time. (If there are any changes in information to this form, please contact Pastor Russ.)

My youth has permission to participate and travel to the Indian Cave Youth Camp (Sutherlin, VA). I also consent to their picture being used in ICYC, FCC & EM Youth related publications, websites and promotional materials (digital and print).

The following information is needed for the Camp Nurse (in addition to those noted on the Medical Release & Permission Form):

General Health of Camper

Physical Handicaps

Limitations

Special Diet

Allergies

Medication

Is camper able to participate in all camp programs? (swimming, field games, etc.)
YesNo
If no, which activities are eliminated?

Are the following immunizations current?
Tetanus:
YesNo
MMR:
YesNo
Polio:
YesNo
Dip Series:
YesNo

Is camper allowed to participate in paintball (optional and costs extra)?
YesNo
(complete additional form which can be downloaded here)

Camper’s Signature

Date

Parent’s (or Guardian’s) Signature

Date

1. If we simply obey God’s Law of Love & be “Ladies & Gentlemen”….We won’t     need any other rule. Hebrews 12:14 “Make every effort to live in peace with     all men and to be Holy; without Holiness no one will see the Lord.”
2. EVERYONE UP & AT ALL MEALS ON TIME.
3. NO CAMPER WILL LEAVE THE GROUNDS WITHOUT PERMISSION.
4. ALL CAMPERS WILL BE REQUIRED TO ATTEND ALL ACTIVITIES & SERVICES.
5. DRESS CODE:
    A. Both boys & girls will be fully dressed at ALL TIMES.
        I. ALL shorts/skorts must have a 6” inseam.
    B. SHOES/ SNEAKERS/FLIP FLOPS are required to be worn at ALL TIMES.
    C. ALL tops, shirts, blouses, etc. should have sleeves or thick straps. No string         straps. (This includes times of play)
        I. NO shirts that bare midriff; even when arms are raised will be allowed.
        II. NO underwear is to be shown at any time.
        III. ALL pants are to be worn properly and not sagging.
    D. EVERYONE will clean up for all evening services.
6. NO SMOKING OR TOBACCO PRODUCTS OF ANY KIND WILL BE ALLOWED ON     THE GROUND. Campers violating this rule will be subject to being sent home     immediately.
7. NO ALCOHOLIC BEVERAGES, DRUGS OR ILLEGAL SUBSTANCES WILL BE     ALLOWED ON THE GROUNDS. Campers violating this rule will be subject to     being sent home immediately.
8. ALL ELECTRONIC DEVICES MUST BE LEFT IN LUGGAGE UNLESS GIVEN     PERMISSION BY THE CAMP DEAN.
9. CAMPERS ARE NOT ALLOWED TO USE THE PHONE; except in the case of an     emergency…so please don’t ask!
10. Due to the possibility of injury & insurance problems; NO CAMPER IS     ALLOWED OUTSIDE OF THE CABINS AFTER LIGHTS OUT; unless going to the     restrooms with a Cabin Leader’s permission. Violators of this rule will be subject     to being sent home immediately.

ANY & ALL questions/concerns with a camper or Staff Member are to be taken to the Camp Dean. Staff Members will need to consult with the Camp Dean with any questions concerning these and all matters. All Staff Members are to uphold all rules and do not have the authority to alter or make changes to the rules.

EXAMPLES OF THINGS TO BRING TO CAMP: toothbrush, toothpaste, soap, deodorant, towels & washcloths, pillow & linens/sleeping bag, flashlight, Bible, notebook & pencil/pen