The Church of God --- Family Camp Application

1. The Church of God --- Family Camp Application For Office Use Only Date: Rec’d Notified Deposit: Rec’d Date Check # Cash Family Plan of Cabin # Cabin Leader: Name: Date of Birth: Address: Current Age: Male Female Phone: Parent/Guardian: Pastor’s Name: Local Church Church Location: How many in family attending camp (Including those serving on staff)? Family Plan of Church Member ____ How Long_____ Positions Held___________________________ City State Zip City State Zip County Parents Name Saved: Yes No Sanctified: Yes No Filled with the Holy Ghost: Yes No Rules for acceptance and participation in the program are the same for everyone without regard to race, color, or national origin. I understand that when I sign this application below, I am agreeing to abide by all rulings and regulations of the camp. If I break any rules I understand that I am subject to disciplinary correction even to the expelling from camp. The Camp Dress Code: To parents and Campers This is a Christian Camp, please dress accordingly. Boys long pants, girls hemline below the knee. To all church services, girls should wear dresses or skirts and boys should wear jeans or slacks. The following clothes are not acceptable: Shorts, Tank Tops, Sheer Fabrics, Skirts or Dresses above the knees. No jams, cutoffs, sleeveless tops. No bear stomach or back showing. No T-Shirts with profane words and/or pictures. Please mark all personal items with camper’s name. Camping staff will NOT be responsible for clothing left on campground.Parent/Guardian will pick camper up as soon as possible after camp is dismissed. If different from Parent/Guardian, who has permission to pick up camper? Name? and Please register by 11:30 AM Camp will end August 5 Please pick up your children, and those you bring to camp by 10:00 a.m. Signature of Camper Signature of Parent/Guardian FAMILY CAMP DATES: August 1 – August 5, 2011 CAMP TUITION: Campers: Ages 2 & Under FREE, Ages 3 – 5 $20 Ages 6 & UP $85.00 Staff: $75 LOCATION: Camp Maranotha 900 Old Mill Rd., High Point, NC 27265 STAFF BUILDING PHONE NUMBER: (336) 869-2251 NOTE: A deposit of $20.00 is required with this application. You may cancel up to one week in advance and receive a refund of deposit. All applications must be received by June 30, 2011 IF NOT THERE WILL BE A LATE FEE OF $10.00 ADDED TO THE TUITION****NO EXCEPTIONS****Mail application to: The Church of GOD P.O. Box 1175Hamlet, NC 28345 Camper’s Health Form ON REVERSE SIDE MUST BE COMPLETE. COST PER FAMILY OF 1 person $ 85.00 2 person $160.00 3 person $235.00 4 person $310.00 5 person $385.00 6 person $460.00

2. Parent/Guardian Information This form must be filled out completely and signed in two places by a parent/guardian before the application can be accepted. Name of Parent/Guardian In Case of Emergency Address Contact Telephone Emergency Phone Health History of Camper Please give approximate dates, if you have suffered: Rheumatic Fever Convulsion Fainting Tuberculosis Sugar Diabetes Kidney Problems Heart Trouble Sleep Walking Ivy or Oak Poison Recent operations or illnesses Allergic Reactions To: Bee Stings Penicillin Other Drugs Details of above or additional information: Any specific activities to be restricted? Important: What is the date of your LAST tetanus shot? Medical Insurance Company name? Subscriber name? Policy # Group # In case of Medical Emergency: I understand an effort will be made to contact the parent or guardian of the camper. In the event I cannot be reached I understand that if any accident should occur, I give permission to the physician selected by the Camp Director to hospitalize, secure proper treatment for and order injection, anesthesia or surgery for my child as named above. Signature Date I understand that if any accident should occur or any sickness which my child may have for which the Camp Insurance does not provide, the expense is my own responsibility and the camp will not be held liable for any expense in such case. (Travel insurance is provided by the camp for each camp activity for the duration of camp, plus travel time before and after camp, if the application is on file in the state office before camp starts.) Signature Date (Name of Adult to be telephoned) City State Zip Medications to be taken during your stay at the camp are to be given to the camp nurse. Please list medication(s): Over The Counter (OTC) Prescription Medicines (RX)

3. Baptismal ServiceThe normal routine for our Church Camp is if a child is saved during our services, or if they are saved before they get here and wished to be baptized again, they have the option to be baptized in a baptismal service held at the last night of our camp.We understand that some parents may not wish for their child to participate in this part of our service. Please sign below in the appropriate box.Again, thank you for allowing your children to be a part of our Family Camp.Family Camp Director, Sis. Brenda OdellBaptismal Service Permission ____ Yes ___ No Signature:________________________ T - ShirtsThe theme this year for camp is “The World Behind Me The Cross Before Me” We are planning to have T - Shirts this year but due to circumstances in the past years and we have lost money on the shirt orders, we will ONLY order what is pre-paid for. If you would like to order a T - Shirt, please check the appropriate size of the shirt and send in $10.00 for the T - Shirt. Again, if you do not send in your money for your shirt by June 30, 2011, then we will not be able to order a shirt. If you want one, please get your money in.Child Small______ Med____ Large_____ Youth Small ______ Med_____ Large______Adult Small______ Med____ Large_____ X-Large_____ XX-Large______XXX-Large______If you need additional sizing, please indicate here:_________________________ Visitors All visitors MUST check-in at the office and fill out a application upon arrival so the Camp insurance can cover you if there is any type of accident or injury. If you come to camp on a daily basis the cost will be $5.00 per meal, overnight stay 1 day with meals is $25.00. Day visitors will have to leave the campground by 10:00 p.m.Snack ShackSnacks is NOT included in on the camp price for snacks in between recreation and classes. If you want your child to have snacks, please send extra money for them to be able to purchase these items. Cabin AssignmentsIf you have a friend at camp that you would like to be in the same cabin with, please list the name of the camper below. PLEASE NOTE: THE CAMPER MUST BE IN THE SAME AGE BRACKET AS YOU IN ORDER FOR THIS TO WORK….Applicant Name:___________________________ Age:_______________Campers Name (in which the applicant would like to share cabin with)______________________Age:____________

4. The Church of God North Carolina Family Camp Prospective Staff Application Section 1 Name Date of Birth Address Age Male Female Telephone Married Single Divorced Widowed Saved Sanctified Holy Ghost Church Member how long? Which local church do you attend? Name of Pastor Note: To be considered for staff one should be saved, sanctified, filled with the Holy Ghost and a member of The Church of God Section 2 For Office Use ONLY Date: Rec’d Notified Deposit: Rec’d Due Check # Cash Family Plan of Bal. Paid By Church Cabin # Staff Room Cabin Leader: City State Zip In what capacity do you feel you are best suited? Teacher Counselor * Dean Recreation Cook Night Watchman Concession Stand Program Director Music Director Evangelist Camp Pianist Nurse RN or LPN *With what age group do you feel best qualified to work? Section 3 Do you hold any position as a church leader? Please give details Are you willing to assume any responsibility you may be placed in? Would you abide by the rules of the camp and tell campers to do the same? Are you willing to forget yourself and put the needs of the camper first? Are you physically fit enough for total participation in the camping program? Can you be at camp on time and STAY UNTIL RELEASED from duties? Do you participate in your local church activities consistently? Will you attend Pre-Camp Training Session, if at all possible, for instruction on duties? Singed Date Section 4 Medical Information Full Name Health History: Check any that apply to you. Epilepsy Diabetes Convulsions Kidney Trouble Asthma Heart Trouble Rheumatic Fever Sleep Walking Serious Ivy, Oak or Sumac Poisoning Allergic to Bee/Wasp Stings Allergic Reactions to Penicillin or other Drugs (List) Please answer: Are you presently taking medications? If yes, list Are you presently on a special Diet? If yes, please explain: Date of last tetanus? Do you have hospital Insurance? Yes No If yes, give name of the Insurance Company Name Policy # Signature Date When you have completed this application, give it to your pastor for evaluation and endorsement. There are many other applicants and we may not be able to use everyone. Please remember you are at camp as a staff member, to e a blessing to campers and assist in their spiritual growth. Fellowship is a second blessing you will receive as a staff member but not the primary reason for working at camp. Put God first, camper second, staff third, self last. Camp success depends upon staff members. STAFF BUILDING PHONE NUMBER: (336) 869-2251

5. PASTOR: Please appraise this applicant prayerfully and honestly. It will give you the opportunity to talk with the applicant about his work in the local church. Please send your endorsement to the State Office within 5 days after you receive it. PASTOR’S ENDORSEMENT Name of Applicant Is Applicant Saved? Sanctified? Filled with the Holy Ghost Is Applicant a church member in good standing? Yes No If Applicant works, does he/she pay tithes? Yes No If no, explain Please rate the following: Excellent Good Fair Poor How is Applicant’s current spiritual condition? Applicant’s attendance to all regular services including midweek? Applicant’s dependability as a Christian year round? How Applicant gets along and works with young people and children? Applicant’s participation and cooperation in local church activities? Applicant’s enthusiasm and genuine interest in camp? Applicant’s Leadership ability in the Lord and the Church? What position(s) of leadership does Applicant presently hold in your local church? If none, please explain Does Applicant boost and support the rulings of the General Assembly including the Advice to Members? Yes No What is the general attitude of Applicant? Explain How is Applicant’s personal grooming, hygiene, dress, etc.? Pastor, would you personally recommend Applicant as a Youth Camp Staff Member? Yes No Comments and Suggestions Have you discussed this evaluation with Applicant? Yes No Pastor’s Signature Date Please Mail To: The Church of God P.O. Box 1175 Hamlet, NC 28345