2020 Application for Camp Wesley Pines

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'Camper' Information

  1. Entering grade

    'Parent 1' Information Copy contact information from 'Camper'

  1. 'Parent 2' Information Copy contact information from 'Camper'

  2. 'Emergency Contact 1' Information

$15.00 LATE FEE ON REGISTRATIONS NOT RECEIVED 2 WEEKS PRIOR TO CAMP DATE!!


All fees are due at least 2 weeks prior to the camp date. This helps to make your registration day run more smoothly and allow you and your camper more time to get settled in before lunch. Remember that it only takes a few minutes longer to fill out ALL the forms. If all forms and money are not received prior to the camp date, you will have to wait until all pre-paid campers are registered. Please take a minute to go over your forms to make sure everything if filled out properly and signed. We want your child's camping experience to be a good one for you and him or her. There is a $100.00 non-refundable fee on all cancellations.


CONTACTING YOUR CAMPER
Family and friends can write to campers c/o Camp Wesley Pines, P.O. Box 307, Gallman, MS
39077. Please DO NOT send candy or gum as campers are not allowed to keep such items in their cabins. The best way for your camper to get notes daily is through Bunk Notes. Information is available on your online registration.

Most snacks can be purchased during canteen time for $ 1.00 per item. Canteens are usually twice daily. Various items can be purchased at the camp store such as t-shirts, tote bags, blankets, personal items, jewelry, caps, etc. Campers are not allowed to make or receive calls except in the case of an emergency. In case of an emergency, the Camp Director may be reached at 601-892-2341. Out of respect for our director, please refrain from calling after 5:00 PM except in a case of emergency.


NOTIFICATION OF ILLNESS OR INJURY
Parents or guardians will always be notified in the event a camper becomes ill or injured.


WHAT TO BRING
Camper should bring twin size sheets, blanket, (or sleeping bag), pillow, pillow case, towels/washcloths, one piece swimsuit (or a t-shirt to wear over a two piece), beach towel, soap, toothpaste/brush, other toiletries, flashlight, sunscreen, insect repellant, casual camp clothes (no short shorts or low cut tops), rain gear, bible, spending money for camp store & canteen (most snacks are $ 1.00 each), note pad, pen or pencil, and stamped envelopes (optional). Campers will be given a time each day that they can write family if they wish.


WHAT NOT TO BRING
Do not bring food items, cell phones, pagers, radios, IPODS, any kind of hand held games, alcoholic beverages, tobacco products, illegal drugs, and weapons of any kind or shaving cream.


CAMPER DISMISSAL
A camper may be dismissed from the camp without a refund if he/she possesses any of the above items or if he/she becomes exceedingly disruptive, destructive or becomes a danger to themselves or others.


REFUNDS
A $100.00 non-refundable processing fee is held on all cancellations. Cancellations on registration day and no shows will receive no refund. If seven days notice is give, you will receive anything above the $100.00 processing fee. Campers who cannot come to camp for some unforeseen reason, pre-registration fee can be used for another camper if the office is notified two weeks prior to camp date.

PARENT’S AUTHORIZATION

My child has permission to engage in all prescribed camp activities except as noted.  The information provided on this form is accurate to the best of my knowledge.  I have indicated any health condition, including required medication and activity limitations which should be known to the camp staff and medical personnel.  I give permission in advance to the physician selected by the Camp Director to order x-rays, routine tests, and other medical treatment for the for the health of my child and in the event I cannot be reached in an emergency, I give permission to the physician selected by the Camp Director to hospitalize, secure proper medical treatment for, and order injects and/or anesthesia and/or surgery if necessary for my child as named above. 
LIABILITY RELEASE FORM


Recreation
The recreation programs at summer event venues strive to offer fun, safe, and challenging activities that engage the whole person—body, mind and soul. Counselors and program staff are trained and as a team committed to your rewarding experience with safety as their highest priority. They have done everything possible to mitigate any risks involved in their recreation programs. However there are inherent risks to participation in recreation activities, including but not limited to, initiative games, high and low challenge course, outdoor education, and aquatics. You could experience any of the following – elevated heart and respiratory rates, uncomfortable group dynamics, climbing or descending unpredictable and possibly slick or uneven terrain, crossing narrow wires and logs, jumping, running, climbing/descending steep rock faces, traveling long distances in remote settings, carrying weight on your backs and shoulders, unforeseen forces of nature or weather, any of which could result in injury/illness that could result in loss of life, limb, and/or property. For more detailed information about the recreation programs offered at Camp Wesley Pines, go to wesleypines.com.


Permission, Acknowledgements, Release, Indemnity
My permission is granted for the camp or event director, church official, any camp or event staffer, or adult present or in charge of first aid, to obtain necessary medical attention in case of sickness or injury to me or my child. Also, I understand that as a Participant, I or my child may be photographed or videotaped during normal camp or event activities, and these photos/videos may be used for promotional purposes. I, the undersigned, do hereby verify that the above information is correct, and I do hereby release and forever discharge Camp Wesley Pines of the United Methodist Conference, the Church, camp or event sponsors and state conventions and their employees (“Released Parties”) from any and all claims, costs, demands, actions or causes of action, past, present or future arising out of any damage or injury in connection with my or my child’s employment by or participation in this camp or event. I agree to indemnify the Released Parties for any and all claims, demands, damages, injuries, costs, suits or causes of action, past, present, or future, arising out of or caused by myself or by my child while participating in this camp or event or while on property leased or owned by any of the Released Parties.


Assumption of Risk
I am aware of the risks associated with participation in the above event and do hereby voluntarily assume full responsibility for any risk of loss, property damage or personal injury, including death, that may result from participation in event activities.


Understanding
I represent and acknowledge that I have completely read and understand this document and all its terms and all matters referred to herein, and I signed voluntarily as my free act and deed, that I have had an ample opportunity to obtain the advice of counsel and that, by signing this document, I understand that I am relinquishing legal rights and remedies that may have otherwise been available to me. I understand that this Waiver and Release shall be construed as broadly and inclusively as is permitted by applicable law and agree that if any portion of this document is held invalid, the remaining shall continue in full force and effect. To the extent the restriction on filing lawsuits is deemed unlawful, I agree to submit any Claims to a Christian conciliation/mediation organization for binding resolution.


Affirmation
Participant affirms that he/she has not been convicted of nor received a deferred adjudication for: a misdemeanor or felony under any state or federal statute regarding crimes against persons, sexual offenses, or violent offenses under the “Participant Name” submitted on this document or any other name or alias. It is understood and agreed that a copy of this form shall be treated as authentic and binding as the original.


Accident Release, First Aid, and Media Wavier


I authorize and grant permission for a representative of Camp Wesley Pines to treat minor injuries and provide over-the-counter medications as needed. I authorize and grant permission for a representative of Camp Wesley Pines to dispense medicines according to the physician’s directions clearly labeled on any prescription medications. I authorize and grant permission to obtain emergency medical care from any licensed physician or hospital and/or medical clinic should my child become ill or injured. I therefore freely and voluntarily execute the release with such knowledge, assume the risk of personal injury and/or property loss arising from or in any way connected with participation in any programs offered by Camp Wesley Pines. I hereby release and discharge Wesley Pines Conference, Retreat and Camping Center and any and all agents of Wesley Pines Conference, Retreat and Camping Center from any liability, claim, and cause of action, demand or damages from injury or damages of any kind to my child or my property as a result of participation in the programs of Camp Wesley Pines. I grant permission and understand that photos and other images taken during this event could be used in print advertisement and other forms of media. I understand my child’s name will not be published.


IMPORTANT: Please notify the camp nurse if the camper has been exposed to any communicable disease during the three weeks prior to camp.

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