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Diocesan Middle School Day Camp 2018

Apr 13, 2018

Please click HERE to read information regarding the 2018 Diocesan Middle School Day Camp before selecting a form to fill out. PLEASE NOTE* the early bird registrations need to be turned in NO LATER than May 30, 2018 to sbrockwell@epiphanychurch.org so she can then turn them into the Diocese. Also note that there is no fee for Camp Counselor or Adult Chaperones. Pay for your youth participant HERE! Camp Counselors will be paid for by Epiphany, and Adult Chaperones are free.

There are 3 registration forms below, please only fill out ONE. The forms below are 1. Youth Day Camp Registration Form, 2. Camp Counselor Application, 3. Adult Registration. 

Youth Registration Form- 2018 Middle School Day Camp

YOUTH INFORMATION


PARENT/GUARDIAN INFORMATION


EMERGENCY CONTACT INFORMATION


MEDICAL INFORMATION AND RELEASE FORM


MEDICAL INFORMATION

In many cases, our staff and volunteers are not familiar with the medical, physical, and/or emotional history of each participant. Please share ANY information relating to the participant in detail. BE AS SPECIFIC AS POSSIBLE.


RELEASE OF LIABILITY AND MEDICAL RELEASE

As parent and/or legal guardian I remain legally responsible for any personal actions taken by the above named minor. I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend the Catholic Diocese of Richmond, its employees and agents, chaperons, or representatives associated with this event from any claim arising from or in connection with my child attending the event or in connection with any illness or injury (including death) or cost of medical treatment in connection therewith, and I agree to compensate the Diocese, its employees and agents and chaperons, or representatives associated with the event for reasonable attorney’s fees and expenses which may incur in any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of the Diocese.
I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child. In the event of any emergency, I hereby give permission to transport my child to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor. In the event of an emergency, if you are unable to reach me at the above numbers I give permission for the noted emergency contact to be notified. I will not hold the Diocese of Richmond responsible for authorizing any medical treatment beyond necessary transportation to the hospital.


USE OF PICTURES AND/OR VIDEO

I give permission for pictures and/or video of my child (named above) engaged in activities related any Diocesan event to have their pictures posted in the Diocese of Richmond publications or websites. Names of participants will not be used without expressed permission from the parent or guardian. If no box is checked below, the Diocese of Richmond assumes you give permission.


YOUTH CODE OF CONDUCT
Youth participants must read, understand, agree, sign and return this sheet with the Medical Information and Release form. Each participant is expected to adhere to the following principles while at the 2018 Middle School Day Camp.

SHOW LOVE AND RESPECT FOR GOD:
 Pray daily for self and others.
 Participate in opportunities to receive the Sacraments.
 Participate in the sessions, activities, and prayer experiences.
 Be open, flexible, and have a servant’s attitude.
 Represent God in your words and actions.
SHOW LOVE AND RESPECT FOR SELF:
 Remember that you are the Temple of the Holy Spirit. Present yourself accordingly.
 No alcohol, drugs, or smoking will be tolerated during the week.
 Dress with modesty. Bare mid-drifts, spaghetti straps, short-shorts, low cut tops, or guys without shirts are not permitted during the week. Appropriate swim wear may be worn on the water park day.
 Any music you bring and listen to should glorify God.
 Drink plenty of water, and make sure you eat all meals. This will allow you to fully participate and not be tired.
 If you must leave an activity, adult chaperones should accompany you since they are responsible for you.

SHOW LOVE AND RESPECT FOR OTHERS:
 All words and actions should be those of Christ to build up others and not injure.
 Make sure that your actions during the activities do not distract others from hearing, seeing, or praying.
 Be safe. No horseplay or other potentially harmful actions. Leave pocketknives, lighters, or other hazardous materials at home.
 No outside or unregistered visitors at the camp will be permitted.
 The facility must remain clean and undamaged. Otherwise, you will personally be responsible to pay for the damage. Any damages caused by the participant will be charged to the participant

I have read, understand, and agree to the above principles. Any violation of the above principles may result in immediate dismissal from the Middle School Day Camp and participants will forfeit their registration fee.

 
 

Camp Counselor Application

ABOUT THE CAMP COUNSELORS
Although the day camp is run by adults, high school students serve as counselors throughout the week to help with the activities. All counselors will step into a role of leadership for the camp, which includes the responsibility to be a good Christian role model for the campers. This high-energy camp is filled with fun games, service activities, small group discussions, time for prayer, and a trip to a water park. Camp counselors will be expected to lead small groups, coordinate and participate in activities for the youth, welcome the youth, lead games, and, as needed, give a short talk.

WHO CAN APPLY TO BE A CAMP COUNSELOR?
Rising 11th grade, 12th grade, or college freshman are eligible to apply to be a counselor.

HOW MANY MEETINGS DO COUNSELORS ATTEND?
Camp Counselors must attend one mandatory training session. This training session will happen in the afternoon on the Sunday before camp week begins at the camp location.

WHAT ARE OTHER REQUIREMENTS FOR CAMP COUNSELORS?
All camp counselors must be able to meet the following expectations:
• Attend the entire week of Middle School Day Camp.
• Arrive to the camp 30 minutes before the start of camp (8:30 am) and stay 30 minutes after the end of camp (4:30 pm) each day.
• Camp counselors who have turned 18 must be in compliance with the Diocesan Safe Environment Policies, which includes completing the following:
▪ Screening One Volunteer Form (every 5 years)
▪ VIRTUS training (once)

WHAT ARE THE DATES AND LOCATIONS OF MIDDLE SCHOOL DAY CAMP


Richmond
Church of the Epiphany
11000 Smoketree Drive
Richmond, VA 23236

Monday, July 9 to Friday, July 13, 2018
9:00 am to 4:00 pm

Contact the Office for Evangelization at the Catholic Diocese of Richmond via phone at 804-622-5159 or via email at evangelization@richmonddiocese.org.

RETURN THIS APPLICATION NO LATER THAN JUNE 21, 2018
TO YOUR YOUTH MINISTER


CAMP COUNSELOR INFORMATION

PARENT/GUARDIAN INFORMATION


EMERGENCY CONTACT INFORMATION



MEDICAL INFORMATION

In many cases, our staff and volunteers are not familiar with the medical, physical, and/or emotional history of each participant. Please share ANY information relating to the participant in detail. BE AS SPECIFIC AS POSSIBLE.


RELEASE OF LIABILITY AND MEDICAL RELEASE

As parent and/or legal guardian I remain legally responsible for any personal actions taken by the above named minor. I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend the Catholic Diocese of Richmond, its employees and agents, chaperons, or representatives associated with this event from any claim arising from or in connection with my child attending the event or in connection with any illness or injury (including death) or cost of medical treatment in connection therewith, and I agree to compensate the Diocese, its employees and agents and chaperons, or representatives associated with the event for reasonable attorney’s fees and expenses which may incur in any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of the Diocese.
I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child. In the event of any emergency, I hereby give permission to transport my child to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor. In the event of an emergency, if you are unable to reach me at the above numbers I give permission for the noted emergency contact to be notified. I will not hold the Diocese of Richmond responsible for authorizing any medical treatment beyond necessary transportation to the hospital.


USE OF PICTURES AND/OR VIDEO

I give permission for pictures and/or video of my child (named above) engaged in activities related any Diocesan event to have their pictures posted in the Diocese of Richmond publications or websites. Names of participants will not be used without expressed permission from the parent or guardian. If no box is checked below, the Diocese of Richmond assumes you give permission.


CAMP COUNSELOR CODE OF CONDUCT
Youth participants must read, understand, agree, sign and return this sheet with the Medical Information and Release form. Each participant is expected to adhere to the following principles while at the 2018 Middle School Day Camp.

SHOW LOVE AND RESPECT FOR GOD:
 Pray daily for self and others.
 Participate in opportunities to receive the Sacraments.
 Participate in the sessions, activities, and prayer experiences.
 Be open, flexible, and have a servant’s attitude.
 Represent God in your words and actions.
SHOW LOVE AND RESPECT FOR SELF:
 Remember that you are the Temple of the Holy Spirit. Present yourself accordingly.
 No alcohol, drugs, or smoking will be tolerated during the week.
 Dress with modesty. Bare mid-drifts, spaghetti straps, short-shorts, low cut tops, or guys without shirts are not permitted during the week. Appropriate swim wear may be worn on the water park day.
 Any music you bring and listen to should glorify God.
 Drink plenty of water, and make sure you eat all meals. This will allow you to fully participate and not be tired.
 If you must leave an activity, adult chaperones should accompany you since they are responsible for you.

SHOW LOVE AND RESPECT FOR OTHERS:
 All words and actions should be those of Christ to build up others and not injure.
 Make sure that your actions during the activities do not distract others from hearing, seeing, or praying.
 Be safe. No horseplay or other potentially harmful actions. Leave pocketknives, lighters, or other hazardous materials at home.
 No outside or unregistered visitors at the camp will be permitted.
 The facility must remain clean and undamaged. Otherwise, you will personally be responsible to pay for the damage. Any damages caused by the participant will be charged to the participant


CAMP COUNSELOR CONTRACT
I understand that Camp Counselors are expected to attend a counselor training session. Counselors are expected to attend each day of the Middle School Day Camp. Counselors are expected to maintain a positive attitude, be on time, show patience with all campers, and share their faith. Counselors are expected to conduct their behavior appropriately at all times at camp and when socializing as a group.
I have read, understand, and agree to the above principles. Any violation of the above principles may result in immediate dismissal from the Middle School Day Camp.

 
 

Adult Chaperone Application

Adult Chaperone Information

SAFE ENVIRONMENT


All adults who participate in a youth event sponsored by the Office for Evangelization must be in compliance with the Diocesan Safe Environment Policies. Please indicate that you have completed each component listed below:

EMERGENCY CONTACT INFORMATION



MEDICAL INFORMATION

In many cases, our staff and volunteers are not familiar with the medical, physical, and/or emotional history of each participant. Please share ANY information relating to the participant in detail. BE AS SPECIFIC AS POSSIBLE.


RELEASE OF LIABILITY AND MEDICAL RELEASE

I agree on behalf of myself, my heirs, assigns, executors, and personal representatives, to hold harmless and defend the Catholic Diocese of Richmond, its officers, directors, agents, employees, or representatives associated with this event from any and all liability, loss or damage arising from or in connection with my participation in this diocesan event.

Furthermore, I hereby warrant that to the best of my knowledge, I am in good health and assume all responsibility for my health. In the event of an emergency, I hereby give permission to transport me to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor or that my emergency contact be notified prior to any further treatment. I will not hold the Diocese of Richmond responsible for authorizing any medical treatment beyond necessary transportation to the hospital.


USE OF PICTURES AND/OR VIDEO

I give permission for pictures and/or video of myself engaged in activities related to any Diocesan event to have those pictures and/or video posted in the Diocese of Richmond publications or websites. Names of participants will not be used without expressed permission from the participant. If no box is checked below, the Diocese of Richmond assumes you give permission.


ADULT CODE OF CONDUCT and EXPECTATIONS

Adult participants must read, understand, agree, sign and return this sheet with the Medical Information and Release form. Each participant is expected to adhere to the following principles while at the 2018 Middle School Day Camp.

Role of Chaperones

The Office for Evangelization depends on Adult Chaperones to help facilitate order and to serve as a network of support for the youth. It is important that the Chaperones be an example of obedience and cooperation with the following policies as well as with our staff and volunteers on site.

Chaperones should be constantly assessing the youth in their group to be aware of any special needs. They should feel comfortable talking and sharing with the youth. Adults should also be willing to pray with the youth in their group. Adult Chaperones are responsible for their students at all times.

Duties of a Chaperone
A Chaperone’s responsibilities include, but are not limited to, the following areas:

1. Participation
✓ It is expected that all camp participants (youth, chaperones, camp counselors) will be present at scheduled sessions during the camp.
✓ At no time should a youth participant leave the site without one of their Adult Chaperones. Unless it is a planned offsite field trip, adults are strongly discouraged from taking youth off site during the camp, except in the case of an emergency.
✓ It is to be understood that the said adult takes full responsibility for a youth once off the site.

2. Relational Ministry and Small Group Leading
✓ It is expected that the adults will engage their youth throughout the day, not only making sure they are behaving appropriately, but participating with them. Adults should sit among their youth and participate with the youth during the camp, unless involved in other duties.
✓ Adult Chaperones will help discipline the youth and help as needed with other camp activities.

3. Alcohol, Drugs, and Smoking
✓ All state laws concerning alcohol and drugs will be strictly enforced.
✓ Possession and/or consumption of alcohol or drugs are not permitted during the camp.
✓ All buildings are smoke-free facilities.

4. Appropriate Dress
✓ All participants are expected to dress in a fashion that represents modesty, respecting other participants and our Lord.
✓ Clothing must cover all undergarments and midriffs. Male participants must wear shirts at all times during the camp. This does not apply to the day spent at the water park.
✓ Adult Chaperones are expected to communicate these expectations to the youth and camp counselors and enforce the dress code at all times.

5. Insubordination
✓ It is expected that youth and adults will follow the direction of all staff and volunteers.
✓ Any instances of lack of cooperation or insubordination will not be tolerated and will be subject to appropriate discipline.
✓ The first and primary method of dealing with discipline problems will be to work through the Group Leader.
✓ The Catholic Diocese of Richmond reserves the right to deny entrance to, or request the ejection of any group or individual who does not comply with the regulations and policies for the 2018 Middle School Day Camp.

I have read, understand, and agree to the above principles. Any violation of the above principles may result in immediate dismissal from the Middle School Day Camp.

 
 

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