If your camper requires medical treatment while at camp, your family's or camper's health insurance information will be used at the hospital.  Please provide that information below.

This section helps our volunteer staff and medical personnel know about your camper's medical needs including:

• Any Medications your camper will take during camp
• Over the counter medications allowed or not allowed to your camper
• Allergies, diet, nutrition, and vaccinations
• General health questions and any restrictions
• Social & Emotional Health

"Medication" is any substance a person takes to maintain and/or improve their health. This includes vitamins & natural remedies. All medications are collected, stored, and distributed by either a volunteer adult with a health care background or by camp health care personnel.

Please list ALL medications (including over-the-counter or non-prescription drugs) taken routinely. Bring only enough medications to last the entire time at camp.  Keep it in the original packaging/bottle that identifies the prescribing physician (if a prescription drug), the name of the medication, the dosage, and the frequency of administration.

Help our volunteers understand your camper's medical history so they can better care for your camper.

What have we forgotten to ask?  If your explanation about your camper's health exceeded the space above, please provide additional information about the camper that you think is important or that may affect the camper’s ability to fully participate in the camp program by emailing Rev. Lara Blackwood Pickrel ([email protected]).

Permission to Photograph

With your permission, the Greater KC Region's Ministerial staff and our volunteer camp staff (counselors and directors) will photograph or video tape your child for the express purpose of promoting the Region's Summer Camp (outdoor ministry), Children's Ministry, and Youth Ministry programs through print media, digital media, or Internet platforms.  Further, the staff of Tall Oaks Conference Center (the facilities the Greater KC Region rents to host our Summer Camp program)  has permission to photograph or video tape your child for the express purpose of promoting their facilities and ministry of hospitality through print media, digital media, or Internet platforms.  Below you can choose to NOT give your permission.

The undersigned person represents that he/she is the custodial parent/legal guardian of the above identified participant. The camper has my/our permission to attend the camping program sponsored by the Christian Church (Disciples of Christ) in Greater KC  from May 1, 2019 to August 31, 2019.

In case of medical emergency, I/We understand that every effort will be made to contact a parent or guardian of the camper. In the event I/We cannot be reached, I/We hereby grant permission to the camp staff to hospitalize, secure proper treatment for and to order injection, anesthesia or surgery for child while attending camp. I/We further release the camp director(s), volunteer counselors, onsite staff, and the Christian Church (Disciples of Christ) in Greater KC from responsibility and liability for any accidents or illnesses occurring during camp. I/We also authorize the camp director or medical supervisor to dispense non-prescription drugs (i.e. Tylenol; ibuprofen) if the situation warrants. I/We understand that the camping experience grows in intensity as the week progresses. I/We recognize that missing any part of the week compromises my child’s experience of intentional Christian community and affects both my individual child and the camp community as a whole. I/We know that the demands outside this camp event may be in conflict with the commitment to spend a week apart in Christian camping, and I/We have chosen to have my child spend a week at camp uninterrupted.  Thus, I/We agree to not text or call my child/youth during the week of camp.

The participant has no physical or mental disabilities that would impair their participation except as noted above. I/We understand that the information provided on this form will be kept confidential and shared only as necessary to provide care of the participant.

Our summer camp, retreat, education and mission trip experiences depend on a commitment to living in intentional Christian community by the participants and the adult volunteers. To do so, we agree to a covenant that helps manage our relationships with one another, our behavior within community, and as a community. We require all participants to read and agree to our Community Covenant below.

Summer camp, retreat, mission trip, or education trips are an opportunity to come to know God while living in intentional Christian community. To ensure every person’s worth as a child of God and each person’s safety, all participants (youth, children, and adults) follow this Community Covenant.

• I will participate fully in all activities.
• I will be respectful to all persons and the camp environment at all times.
• I understand that the adults are present for my safety, for my questions about life and faith, and that they are responsible to uphold the Region’s policies and boundaries as well as that of the camp facilities. I will be respect and trust the adults.
• I will not wander away from the camp, small group, cabin group, or the total group without permission from a counselor. The Region practices, “Two Deep Leadership” to ensure the safety of all participants
• I will respect the personal items of other participants (children, youth, and adults) and respect the personal space and other person's physical autonomy.
• Accidents happen. I understand that my family could be held financially responsible for any repairs needed to property as a result of my actions.

I understand and accept that if I am found with, or participate in any of the following, that I could be sent home from summer camp, from a retreat, education trip, or mission trip experience at my families expense. I also understand that being sent home may limit or disqualify my participation in summer camp, retreats, education or mission trips in the future.

• I will not bring weaponry of any sort (knives, firearms, etc.) to camp.
• I will not bring or consume illegal drugs, alcohol, or tobacco of any sort (or bring/consume prescription drugs that are not prescribed to me).
• I will not steal anything from anyone.
• I will not physically harm another camper or adult.
• I will not participate in sexual activity of any kind.
• If I behave consistently in a way that disrespects the adults, other campers, or the facility that does not reflect the grace and love that is expected of persons who claim Christian faith. 

Summer Camp is ideally Cell Phone Free Zone for campers. Cell phones, Internet hotspots, electronic entertainment devices, game devices, or devices capable of connecting to cell towers often detract from the camp experience. For camps with campers who have completed K-8th grades, these devices are not allowed and should be left at home.  High school aged campers may bring these devices, at the discretion of their camp directors.  At the discretion of high school camp directors, youth bringing these items to camp may be required to check-in the items on the opening day of camp.  If such items are collected during check in and I am found to have these items after the opening day of camp, I understand and accept that I may be sent home.

I look forward to spending time in community with those who share my interest in exploring Christian faith and the practice of Christianity as we play, pray, study, worship, and serve one another following the example of Jesus.