Garaywa camp & conference center

GARAYWA CAMP & CONFERENCE CENTER
A FULL PAYMENT OF $175 PER CAMPER MUST BE MAILED ON OR
AFTER JANUARY 6nd WITH THIS COMPLETED REGISTRATION FORM TO
Garaywa Camp & Conference Center
312 Camp Garaywa Road
Clinton MS 39056-5406
Original forms only – no photocopies
You may also register online atIf you have any questions, please CAMPER INFORMATION – CAMPER MUST HAVE COMPLETED 3rd -6th GRADE
Full Name of Camper ______________________________________ Name Camper Goes By ______________
Age _______
Grade completed as of June 1, 2014 _____________
Mailing Address _________________________________________(Street) _________________________________________ (City, State, Zip Code)
Cabin Mate Request: ____________________________________ You may list ONE cabin mate.
Please do not list multiple cabin mate requests. Only requests made where two campers request each other will be
honored. Every effort is made to place campers with their cabin mate request. However, final placement is at the sole
discretion of Garaywa. No roommate changes will be made within the week prior to camp or upon arrival at camp.
DATES REQUESTED
Summer Camp Weeks: June 9-13, June 16-20, June 23-27 (Girls & Students), June 30-July 4, July 7-11(Girls &
Students), July 14-18
 Girls
(Completed
(Completed
3rd - 6th grades) 2nd Choice ___________
7th-12th grades)
FAMILY INFORMATION

MOTHER/Legal Guardian
FATHER/Legal Guardian
Can camper be released ________________________ Camper lives with:  Both parents  Mother  Father  Other  Joint custody If other, please complete: Name _________________________________ Relationship to camper ______________________________ Mailing Address __________________________ City, State, Zip _____________________________________ Home Phone ___________________ Cell Phone _____________________ Work Phone _________________
EMERGENCY CONTACT In case of emergency and parents cannot be reached.

Relationship to camper ________________________ Home Phone

City, State, Zip
________________________ E-mail address ________________________
CAMPER PROFILE
What church is camper coming to camp with? _____________________________________ City ______________
(If camper is not coming with a group, please indicate in the space above what church she attends.)
PLEASE SPELL OUT THE NAME OF YOUR CHURCH AND INCLUDE THE CITY.
For example, First Baptist Church Biloxi or Covenant Presbyterian Church Jackson.
What church does the camper attend, if different from above? __________________________________________
Is the camper a Christian?
Is this the camper’s first time away from home for a week or more? Does camper have sisters or extended family members at camp this week?
Are there any special situations going on with your child? (For example, recent death in the family, recent move, etc.)
__________________________________________________________________________________________
__________________________________________________________________________________________
List the camper’s hobbies or talents _____________________________________________________________
__________________________________________________________________________________________
List & explain the camper’s fears and concerns, if any. ______________________________________________
__________________________________________________________________________________________
Any other information that would help to improve your child’s camp experience. __________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
HEALTH HISTORY
Health insurance company or organization providing benefits or services. If N/A, please indicate N/A.
Insurance company __________________________________ Policy/ID number_______________________
Company Address_________________________________________________________________________
Doctor’s name & phone number ______________________________________________________________
Camper will be under the care of a physician for the following conditions while she attends Garaywa:
Condition

Check any condition below that may require special care, medication, or diet. If N/A, please indicate N/A.
____Asthma ____Convulsions ____Heart trouble____Diabetes ____ Epilepsy____Fainting ____Bleeding Disorders
____Concussion ____Bedwetting ____ Sleepwalking ____Vision Problems ____Other _______________________
Special Instructions. ____________________________________________________________________________
____________________________________________________________________________________________
Camper is allergic to: If N/A, please indicate N/A.
Drugs ____________________________ Foods _________________________ Plants ______________________
Animals __________________________ Insects ________________________ Chemicals ___________________
Indicate treatment to be administered._______________________________________________________________

ALL MEDICINES are given to the Camp Nurse at registration. No medications are allowed to be taken to the cabin.
Medications will be administered according to written instructions from the doctor or parent. It is not necessary to send
aspirin, Tylenol, cold remedies, or first aid supplies. The Camp Nurse has these. If it is necessary to send medication with
the camper, IT MUST BE IN THE ORIGINAL CONTAINER. ALL PRESCRIPTION MEDICATIONS MUST HAVE THE
ORIGINAL PHARMACY LABEL ATTACHED CLEARLY IDENTIFYING THE CAMPER IN ORDER TO BE
ADMINISTERED, INCLUDING INHALERS AND EPIPENS. SAMPLE PRESCRIPTION MEDICATIONS MUST BE
ACCOMPANIED BY SIGNED, WRITTEN INSTRUCTIONS FROM THE PHYSICIAN. MEDICATIONS NOT IN
THE ORIGINAL PROPERLY-LABELED CONTAINER WILL NOT BE ADMINISTERED AT CAMP. ADULTS
BRINGING CAMPERS ARE NOT TO LEAVE CAMPERS WITH MEDICATION AT CAMP UNTIL
MEDICATION IS PROPERLY CHECKED IN WITH THE NURSE. If you have any questions concerning this,
please call the camp office.
Has camper started menstruation? Ο Yes
Ο No If yes, does she have problems with menstruation? Please explain. ______________________________________________________________________________ Does your child have any physical, emotional, or behavioral difficulties that we need to know about in order to serve your child better while she is at Garaywa? Ο Yes
If yes, please explain. __________________________________________________________________________
____________________________________________________________________________________________
Garaywa is not equipped to handle some persons with certain emotional, mental, or physical disabilities.
Contact the Camp Director for consultation. If your child has emotional or behavioral difficulties that inhibit her
ability to interact successfully and safely in group situations, you may want to consider selecting a camp
environment that is designed to meet her special needs.
Contact Christian Camp and Conference Association @ (719) 260-9400 for camp guides and assistance.
My child can have the following with the agreement of the camp nurse on duty. Tylenol/Advil
Please provide the date of the last tetanus or booster:_______________________________________________

IMPORTANT! Please notify the camp if this camper is exposed to any communicable disease (such as lice, scabies,
strep, etc.) during the three weeks prior to camp attendance.

MEDICAL RELEASE & GARAYWA POLICIES
The health history is correct, as far as I know, and the person herein described has permission to engage in all camp
activities at Camp Garaywa, except as noted by me. I give permission to the camp to provide routine health care,
administer prescribed medications, and seek emergency medical treatment. 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 treatment for,
and to order injections, anesthesia, or surgery for my child as named above.
 Camp session registration will take place between 9:00 and 10:00 a.m. each Monday. Campers are encouraged to be present by 10:00 a.m. Girls should not arrive before 8:45 a.m. unless absolutely necessary. An adult should stay with them until the registration process is completed.  Campers are expected to remain at Garaywa for the entire camp session. Please do not plan for campers to leave for any reason during camp or leave early on the last day. If there is a schedule conflict, please choose another camp session to attend.  Campers and parents are expected to cooperate with camp personnel regarding living area assignments. .
 Emergency phone calls only are allowed. The Camp Director will convey any emergency messages.
 The cabin leaders will supervise and guide the cabin as a unit at all times from registration on Monday until the
camper leaves on Friday at noon. Campers should not be absent from their group at any time without the permissions of the cabin leaders.  Campers are expected to cooperate with corrective measures deemed necessary by the cabin leader and/or activity instructor. Corrective measures will never involve physical contact, emotional, or verbal abuse. When serious problems arise, the Camp Director will be consulted.  Campers are expected to cooperate with the cabin leaders. It is necessary for the campers to work together.
 When requested to do so, parents are expected to pick up a camper in the event of serious disciplinary or medical
 On the last day of camp, parents and leaders are invited to attend a closing session from 10:45a.m. – 11:30 a.m. The camp store will be open after the closing session. Once the closing session is over, adults may pick up their campers from their cabins. You will need to check out your campers from their cabin leaders. If not attending the closing session, please plan to arrive at camp for pick up by 11:45.  PLEASE DO NOT SEND SNACK FOODS, RAZORS (3rd-6th GRADES), ELECTRONICS, SUCH AS iPODS,
iPADS OR CELL PHONES WITH CAMPERS. THESE ITEMS WILL BE TAKEN FROM CAMPERS UPON
ARRIVAL ON MONDAY.

I have read the medical release & camp policies. I understand that my daughter is expected to abide by the policies. The
camp program is designed for her to participate in the following activities: crafts, swimming, Bible study, mission study,
worship, adventure recreation, ropes course and various group games.
SIGNED _______________________________________________________________________________
PARENT or GUARDIAN
WAIVER OF CLAIMS AND RELEASE FROM LIABILITY FOR GARAYWA CAMP AND CONFERENCE CENTER
All participants must have a waiver & release signed by parent and/or guardian.
Event: Summer Camp and/or Day Camp
Child’s Full Name _________________________________
Summer camp is a wonderful experience for children that includes outdoor activities and with these activities comes risk.
Our purpose in this waiver/release is not to worry you, but to point out that there are risks connected with the fun,
excitement and adventure of a camp experience.
I, as parent and/or guardian of a participant at Garaywa Camp and Conference Center, am aware of the inherent risks
associated with participation in camp activities including but not limited to ropes course, swimming, hiking, recreational
games etc. and do hereby voluntarily assume full responsibility for any risk of loss, property damage or personal injury
including death, that may result from my child’s participation in camp activities.
I hereby consent to my child’s participation. I hereby release absolutely, forever discharge, and hold harmless Garaywa
Camp and Conference Center, Mississippi Baptist Convention Board, its members, representatives, officers, agents,
employees and volunteers from any and all present or future liability, claims, demands, actions, whether asserted by me
or a third party arising out of my child’s participation in camp activities. I agree and covenant not to bring or cause any
action in equity or at law against Garaywa Camp and Conference Center, Mississippi Baptist Convention Board, its
members, representatives, officers, agents, employees and volunteers for any and all present or future liability, claims,
demands, actions, whether asserted by me or a third party arising out of my child’s participation in camp activities. I
agree to indemnify Garaywa Camp and Conference Center and the aforesaid parties for any such claims brought by me
or a third party from any costs associated with defending or litigating such claims.
I acknowledge that I have completely read and understand this agreement and all its terms and that, by signing this
document, 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.
CAUTION: READ THIS DOCUMENT CAREFULLY BEFORE SIGNING. THIS IS A GENERAL RELEASE AND
INDEMNIFICATION OF CLAIMS.
Parent and/or Guardian Printed Name: __________________________________
Parent and/or Guardian Signature :_____________________________________
PHOTO PERMISSIONS RELEASE
I know that media will be used to capture pictures and video of camp activities in which my child will participate. I give my
consent and permission for the taking of photographs and/or video of my child during said activities. I grant to Garaywa
Camp and Conference Center the right to use these materials to record the ministry at Garaywa Camp and Conference
Center and/or for promotional purposes.
I GIVE MY CONSENT.
Signed:____________________________________________________________ Date:________________________ Parent or Guardian CAMPER’S CHOICE

Camper’s choice is an activity in which each camper participates for one hour each day in addition to activities at camp
that are done as a cabin. Campers will swim each day with their cabin as a part of regular camp activities. Please
indicate the camper’s 1st, 2nd, and 3rd choices for the activity she would like for this hour each day. She will find out when
she gets to camp which activity she has been assigned.
Girls (Completed 3rd – 6th grades)
_____ Adventure Swim – For advanced swimmers only. Camper MUST be able to swim well enough to pass
swim test. The swim test consists of swimming across the deep end of the pool and back. Please do NOT sign
up for this activity if you are not a proficient swimmer. This activity is in addition to camper’s regular swim time.
_____ Crafts –Create hands-on crafts to take home as memories of your camp experience
_____ Creative Movement –Learn motions to a song that will be performed at the closing session on Friday.
(Not offered weeks 3 & 5)

_____ Drama –Learn a skit that will be performed at the closing session on Friday
_____ Music – Learn how to play a simple rhythm/percussion instrument. This group will be perform at the
closing session on Friday.
_____ Storytelling – This activity is geared toward campers interested in creative writing, reading, and having tons
of imagination! It can incorporate collaborative writing in the form of plays, short stories, songwriting, &
character/world creation.
_____ Recreation –Play a variety of highly active outdoor recreational games
_____ Ropes - Must have completed 5th or 6th grades for this activity. Participate on the elements of the low ropes
course as well as take a ride down the zip line.
_____ Girl Talk - Must have completed 6th grade for this activity. Talk about issues such as boys, dating, modesty,
and self-worth - all while pampering yourself!
Students (Completed 7th – 12th)

_____ Coffee House – Journal and learn to creatively express yourself over a cup of coffee
_____ Crafts – Create hands-on crafts to take home as memories of your camp experience
_____ Creative Movement – Learn motions to a song that will be performed at the closing session on Friday
_____ Drama – Learn a skit that will be performed at the closing session on Friday
_____ Recreation –Play a variety of highly active outdoor recreational games
_____ Ropes – Participate on the elements of the low ropes course including a ride down the zipline

Source: http://www.garaywa.org/wp-content/uploads/2011/08/2014-Registration-Form.pdf