Lakeside Advent Christian Campground

Youth Camp Registration Form 2014

 

Place a mark next to the camp you will be attending:


_____ Teen Camp, $175             _______ Junior Camp, $150


_____YPI


Name: ____________________________________


Address: ___________________________________


City: ______________________________________


State: ___________ Zip: ______________________


Phone: ____________________________________


E-mail: ____________________________________


Birthday: ___________________ Age: ___________


I give Lakeside Advent Christian Campground the right to use pictures of my child on the website.  I understand there will be no identification connecting these images to my child in any way, making the images anonymous for the safety of my child.


__________________________________________

(Parent’s or Guardian’s signature)                               (Date)


Please do not bring:  Any Musical Player, including iPods and other MP3 players, Cell Phones, Electronic Game Devices, Clothing with Inappropriate Messages, Two Piece Bathing Suits


Please bring:  Pillow, Sleeping Bag, Bible, Toiletries, Bathing Suits, Towels


Print and mail to:


Teen Camp                                                              

Nate Tompkins               

8 Aubrey Street

Waterville, ME 04901

(207) 872-0604


Junior Camp

Vicki Davis

11 Eaton Point Road

Deer Isle, ME 04627

(207) 348-6974

Medical Information


Camper’s Name: ______________________________


DOB: ________________________________________


Parent’s Name: _______________________________


Phone #: ___________ Work Phone #: ____________


Emergency Contact: ___________________________


Phone #: _____________________________________


Physician’s Name: _____________________________


Phone #: _____________________________________


List any medical conditions: ____________________


List any medications with dosage and time to be given:

____________________________________________


Allergies:


____________________________________________________

Medical Release:

    In case of medical emergency, I understand every attempt will be made to contact the parents or guardians.  If they cannot be reached, I hereby give permission to the physician selected by the campground to hospitalize and secure medical treatment for my child.

    The person enrolling at Lakeside, and his/her parent(s) or legal guardian(s), assume all risk of lost property or injury to the person, including injuries resulting in death caused by or incidental to dangers associated with the activities at Lakeside and agree that there are certain inherent dangers related to activity participation and therefore agree to hold Lakeside, their owners, board members, members and employees harmless and specifically agree not to make any claim against Lakeside Advent Christian Campground for any of these injuries, which would normally be considered to be a normal risk associated with participation.


Medical Coverage:

    We have a nurse on the grounds; if participant is not feeling well or is injured, the nurse will give immediate medical assistance.  If the injury requires further attention, we will take the participant to Maine General Medical Center at which time we will contact the parent(s) or legal guardian(s).  THE PARENT(S) OR LEGAL GUARDIAN(S) IS/ARE RESPONSIBLE FOR ALL HOSPITAL, PRESCRIPTION, LABORATORY AND DOCTOR FEES.  Please indicate below your insurance information.


Insurance Company: _____________________________________________


Policy Number: ________________________________


Group Number: ________________________________


_____________________________________________

(Parent’s or Guardian’s Signature)                        (Date)