(8-12 years old) Sponsored by Perry Hall Baptist Church

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1 (8-12 years old) Sponsored by Perry Hall Baptist Church Call or us to request a Registration Form and a Health Form. Forms must be returned with full payment. Space is limited Register soon!! Wo-Me-To Camp 1200 Knopp Rd Jarrettsville, Md Monday, July 23, 2018 Friday, July 27, 2018 Theme Directors Speaker Chris Harding Staff Registered Nurse 30 Full Time Michelle Coley / Ana Straw Counselors, Assistants & Workers (on premises at all times) Cost $ (1 st child) / $ (2 nd child) / $ (3 rd child) (If paid after June 1 st, payment will increase by $25.00 per child) Morning Devotions-Home Cooked Meals-Skits-Contest Talent Night-Crafts-Snack Shop-Swimming Recreation-Fun Fair-Water Slide-Camp Fire Just 30 minutes from Perry Hall Baptist Church To get a Registration or for Information call or (410) / ljbondar@usa.net

2 Once again is sponsoring Monday, July 23 rd 2018 to Friday, July 27 th 2018 to be held at a New Air Conditioned Camp Mountain Top Bible Camp 1200 Knopp Rd. Jarrettsville, Md Only 35 minutes from Perry Hall in a beautiful, restful setting, where your child will learn to love nature, will enjoy Recreation, Swimming, Water Slide, a Camp Fire, Arts and Crafts, but most of all they will spend time with God and learn of His Word. This year our own teachers will be sharing their time with your children. We are really blessed to have a great Staff that is willing to spend time with our youngsters. Registration will be on Monday, July 23 (10:00 a.m. until 10:30 a.m.) (Pick up time: Friday, July 27 at 2:00pm) We have 30 full time Counselors, Assistants, Workers and a full time Nurse. We are truly thankful to God for His special provision of workers this year. We are excited because we know that this will be a week that your child will always remember. We are excited that our meals will be served Restaurant Style. (The Maryland State Board of Health inspects the kitchen facilities of the Camp). If you are interested to register your child for Camp, our camp spots fill out quickly so please register right away. Each Camper needs a copy of their personal Health Insurance Card mailed together with the Registration, Health Form and Payment. If you have any questions about Camp, please do not hesitate to call us. We are looking forward to a very special week filled with God s blessings. Camp. P/S: We thank God for the opportunity that he is giving us again this year to serve Him at Mountain Top Bible In His Love, Camp Directors (410) / ljbondar@usa.net For registration to be completed, the Health Form needs to be filled out and mailed together with a copy of your Child s Insurance Card, the Registration Form and Payment. For your convenience we will have a Notary Public on camp premises on registration day (July 23). Please do not sign the Health Form so the Notary can witness your signature.

3 Mountain Top Bible Camp Sponsored by Perry Hall Baptist Church 2018 Camper Registration Boys and Girls (Ages 8-12) 1200 Knopp Rd. Jarrettsville, Md Monday, July 23, 2018 Friday, July 27, 2018 (Arriving Monday, July 24, between 10:00am -10:30am) (Pick up Friday, July 28, by 2:00pm) $275 (1 st child) / $270 (2 nd child) / $265 (3 rd Child) (If paid after June 15th, payment will increase by $25.00 per child) NAME ADDRESS CITY STATE ZIP PHONE AGE Birthdate Weight Height Male Female Father s Name Cell Phone # Mother s Name Cell Phone # Camper resides with Mother Father Both Emergency Contact (other than parents) Phone # Cell # Relationship to the camper How did you learn of MTBC? Is this your first year attending? T-SHIRT SIZE: Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult X-Large Adult 2X-Large BUNK WITH Request: Written request from both camper's parents must appear on both camper's applications. Only up-to two "Bunk With" request will be considered. Cabins are set up by School Grade levels. Please request cabin-mate accordingly. I would like my child to bunk with: 1-2- Camp Program Consent of Parents In consideration of the benefits to be derived, and in view of the fact that membership is voluntary, and having full confidence that every precaution will be taken to ensure the safety and well-being of my child on this camp week activities, I hereby agree to his or her participation and waive all claims against PHBC and leaders of the program. SIGNATURE OF PARENT/GUARDIAN DATE Please return this form with your payment to: Perry Hall Baptist Church Larry & Julia Bondar 6811 New Cut Rd Kingsville, Md For further information call or Larry or Julia Bondar (410) ljbondar@usa.net

4 Health Form If a medical emergency should arise while my child is at camp and I cannot be contacted, I hereby give permission to the camp director to select a physician and/or physicians, to hospitalize, treat, and to order injections, anesthesia, or surgery for my child whose name is: Camper s Name Date of Birth Age on July 23, 2018 Address City State Zip Code Relationship to child Date Parent /Guardian Signature of Parent or Guardian Check and give approximate dates for conditions which the camper has experienced. HEALTH HISTORY DISEASES ALLERGIES (dates not needed) Frequent Ear Infections Chicken Pox Hay Fever Heart Defect/Disease Measles Ivy Poisoning, etc. Convulsions German Measles Insect Stings Diabetes Mumps Penicillin Bleeding/Clotting Disorders Hepatitis B Other Drugs Hypertension HIV Asthma Mononucleosis Other (Specify) Psychiatric Treatment Tetanus Shot Authorization for Swimming The MTBC pool has a shallow water section and a deep water section. Campers who want to swim in the deep water must pass a swimming test given by our lifeguards. There are lifeguards on duty at all times. No camper will be allowed in the pool area without a signature below. Check one: Advanced Swimmer Average Swimmer Non-Swimmer is granted my permission to go swimming while attending camp. Camper s Name Signature of parent or guardian Very important! Please mail a copy of your child s Health Insurance Card with this Health Form. In Case of an Emergency Notify Day Number Night Number Work Number Physician to be notified Telephone Consent and Release Permission granted for above to be examined and treated with (if deemed necessary) over the counter drugs. 1.Pain medication for headache. 3.Laxative for constipation 2.Antacid for stomach-ache/diarrhea. 4.Antiseptic for abrasions and minor cuts. 5.Professional treatment at nearest hospital in care of emergency. If my child misbehaves, I will expect a call from the Director asking me to pick him/her up. Parent/Guardian Signature Date State of Maryland, City/County of Baltimore To wit: Subscribed and sworn before me, This day of 2018 Notary Public My commission expires

5 Physician s Medication Order Form. (This form is needed only if your child needs medication the week of Camp) If your child needs medication during the week of camp, please have this form filled out by physician ordering medication and returned to parent for delivery to Camp on: Monday July 23, Name of Patient Date of Birth The following medications must be given during camp Medication Dosage Hour Given Administration (Specify: Water, milk, food, etc.) For medications listed above, list all side effects, which should be observed by camp personnel List any reasons for not giving medication at the prescribed time (fever, vomiting, drowsiness, convulsions etc ) Physician s Signature Date To Parents: Before the Camp can administer any medication to your child, you are required to sign this authorization form which signifies your desire to have the medication(s) administered, as well as your agreement to relieve the camp of any responsibility for ill effects resulting from the administration of said prescribed medication. I authorize Mountain Top Bible Camp to administer the medication(s) prescribed by our physician and relieve the camp of any responsibility for ill effects, which may result from the administration of said medication. Parent s Signature Date