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Cordova Christian Camp – Camper Registration – 2012

Children, Events | Comments Off

I understand registratin is on a first-come, first-served basis. I would like to be placed on the waiting list.
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Yes

Camper’s Information (10 questions)

Camper’s last grade completed (by June 2013):
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Camper’s gender:
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Male

Female

Camper’s last name:
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Camper’s first name:
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Camper’s birth date
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Camper’s age:
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Address:
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City:
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Zip Code:
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Camper’s Home Phone:
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Parental or Guardian Information (23 questions)

Email:
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Father’s (or Guardian’s) first name:
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Father’s (or Guardian’s) last name:
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Father’s (or Guardian’s) Home Phone:
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Father’s (or Guardian’s) Work or Cell Phone:
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Father’s (or Guardian’s) Address:
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Father’s (or Guardian’s) City:
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Father’s (or Guardian’s) Zip Code:
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Mother’s (or Guardian’s) first name:
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Mother’s (or Guardian’s) last name:
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Mother’s (or Guardian’s) Home Phone:
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Mother’s (or Guardian’s) Work or Cell Phone:
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Mother’s (or Guardian’s) Address:
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Mother’s (or Guardian’s) City:
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Mother’s (or Guardian’s) Zip Code:
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Emergency Contact #1 – first name:
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Emergency Contact #1 – last name:
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Emergency Contact #1 – Day Phone:
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Emergency Contact #1 – how related:
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Emergency Contact #2 – first name:
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Emergency Contact #2 – last name:
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Emergency Contact #2 – Day Phone:
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Emergency Contact #2 – how related:
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Camp Options (2 questions)

T-shirt Size:
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Camper would like to participate in the bike ride:
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Will not participate

K-6 – stays on the church grounds

3rd-6th – Rides out on the American River Bike Trail

Medical Release (12 questions)

Camper takes medication (if yes, please explain in comment box below):
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Yes

No

Special dietary needs:
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Camper is able to participate in normal physical activities (if no, please explain in comment box below):
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Yes

No

Camper has asthma:
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Yes

No

Other special medical information or health problems:

In case of emergency, I can be reached at the following phone #
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In case of accident or injury, I give permission for the camp director or medical staff at Cordova Christian Camp to authorize emergency treatment for my child.
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Yes

No

Doctor’s name:
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Doctor’s Phone number:
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Insurance Carrier:
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Medical Policy Number:
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I, the parent or guardian, consent to the camper’s participation in Cordova Christian Camp. I affirm that camper is in good health and that he/she is not under a physician’s care for any undisclosed condition that might endanger his/her health or that of other participants. I authorize in advance the medical camp staff to consent to any emergency medical or surgical diagnosis, treatment, and/or hospitalization which is deemed necessary during the camp hours for the week of camp and agree to be financially responsible for all said treatment. I also agree that the camp is not responsible for camper’s before or after the hours of the camp. I understand that I will be required to pick up my child if he/she does not abide by the camp rules. I hereby release the staff and any supporting group from any financial liability for this applicant’s participation. I have read and understand this agreement.
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Yes

No

Additional Comments

Comments:

Important Dates

June 17 – Camp Orientation & Father’s Day BBQ – 5:30PM

June 18-22 – Camp (8AM-3:30PM)
- Morning Check-in – 8-8:30AM
- Afternoon Pick-up – 3-3:30PM

June 24 – Slideshow @ 5:30PM
- Dinner @ 6PM

Daily Schedule

7:30 AM – Staff Meeting
8:00 – 8:30 AM – Morning Check-in
8:30 – 9:30 AM – Morning Worship & Lesson
9:30 – 10:00 AM – Snack & Special Activity
10:00 – 12:00 PM – Sports & Electives
12:00 – 12:30 PM – Lunch
12:30 – 1:30 PM – Veggie Tales
1:30 – 2:30 PM – Class
2:45 – 3:00 PM – Snacks
3:00 – 3:30 PM – Camper Pick-up
3:30 – 4:00 PM – Staff Meeting
4:00 PM – Cleanup

Slideshows from 2012

Monday’s Slideshow

Tuesday’s Slideshow

Wednesday’s Slideshow

Thursday’s Slideshow

Friday’s Slideshow

Energizer Videos

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Rancho Cordova, CA 95670
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