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Lansing Area and Zone Youth Registration form
Any questions concerning this form, contact Pastor Sam Stone (517)-243-1159
PARENT/GUARDIAN CONSENT AND RELEASE FORM FOR RIGHT OF PASSAGE EXPERIENCE (R. O. P. E.) CAMPS
This form is for Campers the age of twelve at the start of camp through eighteen.
Lansing Area and Zone Youth Expectations:
 Do not bring any electronic devises including: ipods, mp3, digital camera, games, cell phones.  There will be emergency numbers supplied to all parent-guardians to be in contact with the camp.
 AGES FOR R.O.P.E. CAMP-  CAMPERS MUST HAVE REACHED THEIR 12TH  (TWELVETH) BIRTHDAY BY THE START OF CAMP.
 Respect yourself, others and the property of others, no fireworks.
 Follow Leaders instructions, stay in area assigned, no wandering.
 Do not use language that is abusive to staff or fellow youth.
 Dress modestly.  Shorts should be fingertip length. No strapless, tank tops, or string tops. All bathing suits need to be modest. Girls swimsuits MUST BE one piece.  Tankinies can be used if they cover the mid-section. Cover ups for boys and girls must be worn from camp area to swim area.  Cover up can be an oversized tee shirt and shorts or outer garment(s).  Any questions, please contact Pastor Sam.  If not adhered to you will not be allowed to swim.

Parent/Guardian Wavier/Permission:
Lansing Area and Zone Youth does not discriminate due to race or national origin.
I approve the participation of my minor child in Lansing Area and Zone Youth activity and waive any and all claims against the same, its Officers, Leadership Committee, the Church of the Nazarene, Michigan District Church of the Nazarene, Lansing Zone, due to injury or other damages incurred to the activity participant, or said property to the activity participant in connection R.O.P.E. Camp.  I assure that my child is in good physical health and is able to attend this R.O.P.E. CAMP.

I UNDERSTAND  PART OF THE CONTENT OF THIS CAMP IS ABOUT SEXUAL PURITY AND MORALITY.  THAT THESE TOPICS WILL BE DISCUSSED IN DETAIL.

I authorize the Lansing Area and Zone Youth association to render necessary routine first aid and medical care as required. In the event of an emergency, I give permission to the licensed physician chosen by Lansing Area and Zone Youth association to hospitalize, secure treatment, anesthetize or perform surgery for the activity participant named on this form below. I give permission for Lansing Area and Zone Youth to use my child’s picture (video or photograph) for publicity purposes.

I give permission for _______________________________ to take part in Right Of Passage Experience (R.O.P.E.) Camp 
(Name of youth)                      (Name of activity)
on this day ______________________  Parent/ Guardian Signature:   _____________________________  Date:  _____________

Activity Participant Agreement:

I have read and agree to abide by all the rules of Lansing Area and Zone Youth.

Activity Participant Signature: __________________________________

Registration:

Name: ____________________________   Address: ___________________________  City:______________ State:___

Zip:_________  E-Mail Address:  ____________________________  Home Phone: ________ Cell:__________ 

Parent (s) Name:_____________________  Address:____________________________ (If different from above)
Emergency Contact Information

In an emergency, parents are contacted first. List an additional contact person.

Name: ______________                 Phone: ________

Please fill the medical information sheet below for medications, name of physician, and other details that are needed.  Put "None" in areas that do not apply.
Please make a copy of insurance card and attach to this form.

Emergency Phone Numbers for Boys Right Of Passage Experience ROPE Camp:

Pastor Sam Stone:  517-243-1159( Boys and Girls Camp)
Indian Lake Nazarene Campground:  269-649-2281  (Boys and Girls Camp)
Anna Stone:  517-599-9967  (Boys and Girls Camp)
Ron Turner 517-803-7464  (Boys Camp)
Rob Wing-Proctor  517-488-2718  (Boys Camp)
Jan Harrington 517-898-2051  (Girls Camp)

What to bring to ROPE camp
The following are Required Items:
1. Parent-Guardian release form- read and signed by both parent-guardian and camper
2.  Medical information form- (on back of p-g release form or located below on this page)
3.  Copy of insurance card or information (in case of emergency)

The following are suggestions and recommendations:
Sleeping Bag
Pillow
Toiletries- Personal Items
Toothbrush
Soap
Shampoo
Towel for bath
Towel for swimming
Swim Suit-Follow dress code*
Cover up-Follow dress code**
Repellant
Sun Screen
Extra set of clothes-socks, pants, shirt, underwear, shoes, flip flops, etc....
Bring some warm clothes
Disposable one time camera (optional)
Rain coat or poncho
Fishing pole and tackle
SWIM SUIT DRESS CODE  *Girls and boys swimsuits MUST BE MODEST and one piece. No strapless tops. Girls may use tankinies if they cover the mid-section. **Cover up must be worn from camp area to swim area.  Cover up can be an over sized tee shirt and shorts or outer garment(s).  Boys must also wear cover up to and from swim area.

Medical Information:
On the back of the Parent-Guardian Release form:
1. List each Medication, Strength of Medication, Dose, Times Given/taken and any other directions for the medication.  If your camper does not require any medication, please state this on the back of the form.
2.  List the name and phone number of campers physician.
3.  List any other conditions that needs to be addressed for us to be aware of for this camper.

What not to bring to ROPE Camp.

Please do not bring any electronic device, for an example:  No I-Pods, mp3, cd, dvd, notepads, digital cameras, cell-phones!
We have phone numbers available for parents or guardians to call the camp leaders in case of an emergency.  All electronic devices will be turned in to the camp leaders and kept in a secure place until later after the camp.