Texas BaptistsAccounting & Finance, ATTN: Camp Exalted

7557 Rambler Road, Suite 1100 I Dallas, TX 75231-2310campexalted@texasbaptists.org

FILL OUT THE FOLLOWING REGISTRATION FORMS

AND RETURN TO:

JULY 6-JULY 10, 2018L ATHAM SPRINGS

STUDENT REGISTRATION FORMS

PAYMENT INFORMATION

STUDENT’S NAME / (first) (middle) (last) (pastor’s name)

ADDRESS

CITY

STATE ZIP

HOME PHONE ( ) CELL PHONE ( )

E-MAIL T-SHIRT SIZE: q S q M q L q XL q XXL q XXXL

CHURCH NAME / (pastor’s name)

CITY PHONE ( )

[ PAGE 1 OF 3 ] QUESTIONS? CALL 510.529.6369 ALL INCOMPLETE REGISTRATION FORMS WILL BE RETURNED.

• Early Registration $225–due April 30, 2018

• $100 Deposit, registration forms, and waivers are due April 30, 2018

• Regular Registration $250–due June 1 - June 20, 2018

• $100 Deposit, registration forms, and waivers are due June 1 - June 30, 2018

• Late Registration $275–due June 21 - July 1, 2018

• $100 Deposit, registration forms, and waivers.

• Any leader or church wanting to register after July 1 must contact Teresa Carson at teresa.carson@bbcmansfield.org.

• Remaining balance of registration fees is due June 30, 2018.

REGISTRATION IS NOT COMPLETE WITHOUT INSURANCE INFORMATION AND REQUIRED WAIVERS.

STUDENT CONTACT INFORMATION

GRADE ENTERING IN FALL 2018: q 7th q 8th q 9th q 10th q 11th q 12th q Graduate

q College Freshman q College Sophomore q College Junior q College Senior (age)

STUDENT REGISTRATION FORM

JULY 6-JULY 10, 2018L ATHAM SPRINGS

Texas BaptistsAccounting & Finance, ATTN: Camp Exalted 7557 Rambler Road, Suite 1100 Dallas, TX 75231-2310

STUDENT NAME

DATE OF LAST TETANUS SHOT (MM/DD/YY) / / BIRTH DATE (MM/DD/YY) / /

STUDENT’S SOCIAL SECURITY NUMBER – – SEX q M q F

[ PAGE 2 OF 3 ] QUESTIONS? CALL 510.529.6369

I, , parent and/or legal guardian of , a minor, do hereby acknowledge that said minor is presently under my care, custody, and control. I hereby give my child, the said minor, my express permission to attend Camp Exalted. I further expressly grant my permission for my child to participate in all activities of the camp. I have listed above said child’s physical conditions or medical problems that may need attention, and all medications regularly used by said minor. I understand that all medical information will be kept confidential and will only be released on a need to know basis for care of said minor. In the event there arises an emergency necessitating medical or surgical attention, I hereby consent and give my permission to Camp Exalted staff of the Baptist General Convention of Texas, or its representatives, or the church sponsors, or any attending physician to make such decisions and to perform such medical treatments and/or surgery upon said child which may, in their sole discretion, be necessary and proper under the circumstances. I also consent and give permission for said child, at his/her own discretion, to participate in counseling sessions while attending Camp Exalted. I do release, acquit, discharge and covenant to hold harmless the Camp Exalted staff personnel, the Baptist General Convention of Texas, or its representatives, or the church sponsors, or Latham Springs, from any and all actions, damages, liabilities arising out of treatment of any sickness or accident incurred by said child during the above dates. I also give authority and permission to Camp Exalted security/patrol staff to inspect my child’s room and belongings while on campus for the safety and protection of all Camp Exalted participants if unusual circumstances make such an inspection necessary.

8 DATE 8 DATE (parent or guardian signature) (student signature if over age 18)

EMERGENCY CONTACT #1 EMERGENCY CONTACT #2

RELATIONSHIP TO STUDENT RELATIONSHIP TO STUDENT

PHONE ( ) PHONE ( )

2ND PHONE ( ) 2ND PHONE ( )

MEDICAL INSURANCE COMPANY (ATTACH COPY OF INSURANCE CARD)

PLAN OR GROUP # INSURED ID OR MEMBER #

INSURANCE COMPANY PHONE ( ) 2ND PHONE ( )

INSURANCE COMPANY ADDRESS

CITY STATE ZIP

STUDENT MEDICAL & SURGICAL WAIVER To be completed, signed and dated by parent or legal guardian of student. Students over age 18 must also sign and date. Incomplete forms will not be accepted.

ALL INCOMPLETE REGISTRATION FORMS WILL BE RETURNED.

REGISTRATION IS NOT COMPLETE WITHOUT INSURANCE INFORMATION AND REQUIRED WAIVERS.

STUDENT MEDICAL FORM

DO YOU HAVE, OR HAVE YOU HAD :

q A RECENT SERIOUS INJURY q A RECENT SURGERY q ALLERGIES TO MEDICATION(S)

q A CHRONIC MEDICAL CONDITION (like asthma or ADD)

If yes to any above, please describe:

Are you taking any medication(s) at the present time (for asthma, allergies, etc.)? q YES q NO

Are you bringing these or any other medications with you? q YES q NO If yes, please list. Use additional sheet to include further informa-

tion.

(medication) (dosage) (time(s) taken)

(medication) (dosage) (time(s) taken)

MEDICATIONS TAKEN OCCASIONALLY (FOR HEADACHES, ETC.)

FAMILY PHYSICIAN PHONE ( )

STUDENT HEALTH INFORMATION In case of accident or special health needs, it will be necessary for us to have the information below. Please make sure you have filled in the blanks completely. Write “none” or “na” if appropriate; a blank space does not mean “none.”

STUDENT EXPECTATIONS AND RULESWe have high expectations for your behavior as an African American Youth Camp participant. Those expectations are listed below. Please take some time to become familiar with them. By respecting these guidelines, you assist in making this a tremendous week of focusing on what God wants to accomplish through you, and making it a fun, safe week for everyone. Your example in following the rules will encourage others to do the same.

[ PAGE 3 OF 3 ] QUESTIONS? CALL 510.529.6369 ALL INCOMPLETE REGISTRATION FORMS WILL BE RETURNED.

REGISTRATION IS NOT COMPLETE WITHOUT INSURANCE INFORMATION AND REQUIRED WAIVERS.

1. Students are not allowed off of Camp Exalted grounds for any reasons whatsoever. Students must remain ON CAMP GROUNDS from the moment of check-in on Monday afternoon until check-out on Friday at noon. In this way, your attention can remain focused upon what God has to teach you while you are at Camp Exalted.

2. Late arrivals and/or early checkouts are not permitted. All students will be required to attend all school sessions, family group times, recreation, meals, and worship services, beginning with check-in on Monday through the final session on Friday, which concludes at 11:30 AM. You must be with your assigned school or family group during all scheduled activity, whether in the classroom, auditorium, or on the athletic field. There are no exceptions to this unless you are injured or sick and are at the nurse’s office, medical clinic, or hospital. Being present at each session, discussion time, activity and worship time allows you another opportunity to discover how you can apply biblical truths to your own life and in your interactions with other people.

3. Students are not allowed to ride in or on any vehicle. For everyone’s safety, all persons will walk while attending Camp Exalted. While on camp grounds, Camp Exalted participants will not use cars, buses, vans, motorcycles, skateboards, rollerskates, or roller blades. All other vehicles (including motorcycles) must be parked in the Camp Exalted parking lots from the time of check-in on Monday until 11:30 AM Friday. Some golfcarts will be reserved for use only by selected Camp Exalted administrative staff in order to serve students’ needs better and to facilitate quick arrival in emergency situations.

4. Students must go straight to their classroom and must leave the building when the class is over. No loitering inside or outside the building before your class starts or after your class is over. Do not stand around in the lobby, on the stairwells, or around Coke machines.

5. In the event of illness or injury, students will not be permitted to remain in their cabins. Students who are ill or injured will be required to rest in the Camp Exalted nurse’s station or seek medical assistance in the nurse’s office or medical clinic until they are able to return to the regularly scheduled activity or session of their school. This allows us to be certain that your physical and health needs are met.

6. Students must indicate what medications they will use at Camp Exalted; students are not allowed to share any medication with any other student. All medications each student uses or brings with them to Camp Exalted are to be listed on the Registration/Medical Release Form and/or the Medication Information/Administration Release Form and checked by the Camp Exalted nurse at check-in time on Monday. Students must not share any medication, including aspirin or other pain relievers, or any other over-the-counter or prescription medication, with any other student. This protects the safety and liability of the students and staff. All medications will be administered by the nursing staff only. No exceptions.

7. Students MUST be in the cabins each night, Monday through Thursday, by 11:00 PM. Lights out at 11:30 PM. All students are required to be inside their assigned dorms by 11:00 PM. Cabins are locked at this time, and there are no acceptable excuses for not being in your cabin by 11:00 PM. Your curfew is for your safety and for your mental and physical well-being, and because the daily schedule is very demanding—you’ll need your sleep. Adults in Leadership Forum have no curfew, but curfew applies to ALL students and Team Leaders.

8. Under NO circumstances are girls to be in boys’ rooms or boys in girls’ rooms. This includes hallways outside the cabins, too. NO EXCEPTIONS!9. Drugs, alcohol, any form of tobacco, any type of paint, firearms, knives, or any other kind of weapon, or fireworks are NOT allowed. These items can be destructive to you,

to others, and/or to the campus property. 10. CLOTHING NOT ALLOWED FOR BOYS AND GIRLS - SLEEVELESS SHIRTS OR DRESSES, SHORTS OR SKIRTS SHORTER THAN 2-INCH ABOVE THE KNEE, ALL SHEER

CLOTHING AND LOW-CUT NECKLINE DRESSES. (Any students wearing clothing determined to be too short or revealing will be asked to change. Repeat disregard for dressing appropriately will be considered a violation of Camp rules.) Shorts will be allowed during the evening worship services as long the shorts are the appropriate length. Choose clothing that will allow you to be comfortable for small group outside activities. Students clothing should reflex a godly persona and not divert the attention of those around you from their focus on God, His Word and His purpose in their lives. Moderate clothing is acceptable during all activates at Camp Exalted.

11. Students must refrain from Public Display of Affection (PDA) with girlfriends or boyfriends for the duration of the camp. This type of behavior is highly unacceptable and inappropriate for Camp Exalted participants. You should use this week to focus on your relationship with God, so put the relationship with your girlfriend or boyfriend on hold for a week.

12. Ordering food to be delivered to camp grounds is forbidden. In fairness to everyone, we’ll all eat at the cafeteria. You may bring snacks with you to keep in your cabin, but you will still be expected to show up at the cafeteria at mealtimes. We suggest that if you bring snacks, they be in tightly sealed containers, such as zipper-lock plastic bags or plastic storage containers.

13. Students must obey encampment rules and regulations. We are guests on the camp grounds, and must abide by their rules and regulations concerning cabins, dining halls, and all other facilities. Be respectful of encampment faculty, personnel, and guests. By signing this Camp Exalted regulation and rules portion of Camp Exalted registration, you are entering into a “contract” with Camp Exalted. Your signature indicates that you know—and your pastor and your parents know—that if you fail to use good judgment and common sense in following the rules above, you will be dismissed from Camp Exalted and returned home at your own or your parents’ expense. Generally, your behavior should reflect these three basic things: 1) Be where you are supposed to be, when you are supposed to be there, doing what you are supposed to be doing, 2) Always pray, always be on time, always be flexible, and 3) Have a good attitude and a teachable spirit. The Camp Exalted staff wants you to be happy and to help you have the greatest week of your life, as you grow in your own personal discipleship to the Lord Jesus Christ and learn to share the joy of your Christian life with others.

14. This form also serves as a release to appear in photographs and/or videos while participating in Camp Exalted for publicity, training, and/or promotion purposes.

I HAVE READ ALL THE RULES ABOVE, I UNDERSTAND THEM, AND AGREE TO ABIDE BY THEM.

8 DATE 8 DATE (student signature) (parent signature)