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tn tflnER THEllIU EITYBflllNNtl RflP,Rlll!l{, fillI uftlR!ililP ufil.t,BRilltift flltf$iltTHftT RtlfllRllu flxpflRt|!|lrl|l |l|ll'flR!il10nflT Tfit! PEnfi-,Jt!R$EY Rt!tTRil!T Yillft't{ |!fl|np! Pfl$T|lR IIflYO BEYOR, FIIUIIBCIR |lF NEUEITY EHUREH flIIBBfIIIIIIIIIll BETHI$YflflR$$PO[II{[R. t{t!lfllt!!l$filit!$ uilt,t, B0R[fil,,n[1El'fillT, pRrnHpr,fllt . flnRRH,ftTt|lnfl[ - n|lRE |lF THU fl|l[ TH0pflfln-J|lR$[y % ll|Iu nrTYBflnR e ,llllTRil]T Y0tfTH. To find a printable version of this inforrnation and the registration form go to: www.penn-ierseydistrict.org and click'Ministries' then'Youth.' For questions please contact: Penn-lersey District Youth Gamp Director Rev. Justin Leininger - Phone: (61O) 767-f 239 - Email: [email protected]

Penn-Jersey District Youth Compis for students going into seventh grade through high schoolgroduotion. our compoffers impoctful rollies & worship,connectionwith Wesfeyoncolle-geteoms & other Wesleyonyouth, doytime ond nighttime sports ond octivities, ond g?eat meals& snackshop. Feel free ?o check out the swimmingpools,dinningoreos, ond meetingplocesof our beoutiful compgroundsot The Tuscarora Inn & Gonference Genter Mt. Bethel, PA - 570-897-6000 - www.tuscarora.org COMMUNITYSTANDARDS The followingcommunitystandardsare set by Tuscarora Inn and/or Penn Jersey Youth Camp Staff. We believe these guidelineswill help you and othersenjoy the overall camp expenence. Possessionand use of illegaldrugs,alcohol,and tobaccois strictlyforbidden. Prescription or over-the-counter drugsmustbe givento the camp nurselor the safetyof yourselfand others. Encouraginga positivecamp communityincludesno fighting,swearing,disrespect and gossip. All teens must be presentat all mealsand rallies.No sleeping duringrallies. Participation in public displaysof affectionmay be a distraction to yourselfor othersand is not allowed duringcamp. Stay within the camp boundariesand out of off limit buildingsincludingbuildingsof the oppositesex. Guys and Girls are to dress modestly by not wearing two-piecesuits or Speedos. Undergarments are not lo be visibleiskirtsmusttouchthe too of yourkneesin a standingposition.Guysmustwear shirlswhennot swimmino.

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YOUTH CAMP COSTS Mailedby June 22nd- $225.00 A non-refundable depositof $100alongwith the completedregistrationforms must be postmarkedby June 1grh,2009. Mailedby July zoth- $zzs.oo A non-refundable depositof $100alongwith the completedregictrationforme must be postmarkedby July 1lh, 2009. MailedafterJuly 17rhlwalk-On - $325.00 At this point space is not guaranteed. NOTE:ALL PAYMENTS must be receivedby augusTT6@u try to watk-onand register(spacenot guaranteed). FAMILY ASSISTANCE

Must be received by July 6, 2009. lf a family has two or more teens aftending W H AT T O BR IN G T O C AMP camp we may offer a reducedrate to help with the cost of camp. To be eligiblethe Bible.notebook.& oen applicantmust fill out the Assistance Toiletries(deodorant, towels,gel, Application beforethe registrationdeadline. toothbrush,etc) lf accepted,registrationsmust be in with your Sleepingbag & pillow depositby July 20,2009.Ratesare as follows: Swim Suit (no 2-piece) Plentyof clothingfor five days ; t'/i
PleaseNote: TuscaroraInn and the Penn-JerseyDistrict is not responsiblefor lost or stolen items. Any itemsfound distractingto campwill be takenaway. (Thisespeciallyincludescell phones!)

OTHERINFORMATION -Camp registration is conducted between 1:00PMand 3;00PM,Mon.Aug.17th -Campconcludesfollowingthe noon ireal on Fri.Aug. 21"'

CAMPER REGISTRATION Gamper'sName Address

City

State_

Zip

Church Age_ M/F T-ShirtSize(S- XXXL)

I grantpermission for my son/daughter to attendthe Penn-Jersey DistrictYouthCamp,August17th-21"t. Relation to Camper. Date / / Signature, WaterActivities grant permission I for my son/daughter participate to in supervised waterfront andwateractivities. Signature. Date //

Regi stration DeadIi n es: (Postmarkedby thesedates) Monday, June 2fo for the $225 cosf Monday, July 20thfor the $275 cosf Anything postmarkedaftelJuly 17thwllt be considereda walk on registrationat $325 ALL PAYMENTSMUSTBE RECEIVEDBEFORE MONDAY,AIJGTTST lOTH! Pleasemail registrationform and a minimumof $100depositto: PastorShannonD'Agostino 443WalnutStreet Millersburg,PA 17061 Please make checks payable to: Penn-Jersey District Youth

Medical ReleaseForm

Camper'sName Parent/ Guardian (night) Phone(day) Cell# Do you havemedicalinsurance? _yes _no Company Group# Policy# In case of an emergencyor injury,the hospitalwill not treat unlesspermissionhas been granted by phone from the parent or other relative. Please list additional phonenumberswhereyou or anothercloserelativecan be reachedday or night. Nameof additionalrelative(s) Relationship

Phone

FamilyDoctor Address/ phone Pleasecheckall thatapplv: _Nose bleeds_Upset Stomach_Bed Wetting _Convulsions_Rheumatic Fever_Diabetes lnfections: _Eye _Ear _Nose _Throat Allerqies: Asthma Hay Fever_lnsect Stings _Penicillin _Drug/Food(specify) Other

Dietaryrestrictions Activityrestrictions Dateof lastTetanusshot Medications that

must

be

taken

This is for the followingcondition(s) Whenis the medication to be taken? Doesthe medicationhaveside affects?

lf yes,whatcanbe doneto preventthis? In theeventthatthechildbecomes illor injuredI givepermission forthenecessary treatment at the nearestmedicalfacilityandfortransportation to thatfacility. ParenUGuardian Signature