Camp McDowell Summer 2007 Application Form

For Primary I and II both parent and child must have separate registration forms (deposit is $25 each)
Please circle if this form is for a CHILD or PARENT
A $50.00 deposit is required for all registrations. Balance is due 10 days prior to Camp Session.

Session ________________________

Name of Camper____________________________________________________________________________

                                    Last                              First                     Prefer to be called

Circle:      Male / Female                       Grade Next Fall ________           Date of Birth      /      /         Age________

School Name________________________________ Have you ever been to Camp McDowell before?______

Parent Name ___________________________________________ Email: _____________________________

                                    Last                              First

Street Address _____________________________________________________________________________

                                                City                              State                            Zip

Phone:  Home ____________________________Work (Dad) ____________________________

    Work (Mom) ____________________________           Cell _____________________________

Emergency Contact: ____________________________________ Phone: __________________________

Are you an Espicopalian?  Y  /  N  If so, what parish?______________________________________

If not, what is your religious affiliation?_______________________________________

I would like to be in the same cabin as (one name only, please)________________________________________

(We will only guarantee your request if the person you name also requests you as a cabin mate).

(Information on this form will only be shared with medical agencies as required to provide necessary medical treatment).

HEALTH INFORMATION:  Tetanus _______(year)   Height _______  Weight________lbs.  Contacts?  Y  /  N

If you are allergic to any of the following, please circle:  Insects   Food   Plants   Animals   Medicine   Other

*on back of this form or on additional paper,  identify the specific allergy and what should be done if exposure occurs.

Current Medications:__________________________________________________________________________

Health Problems:_____________________________________________________________________________

CAMPERS:  Please read and sign the following statement:

If accepted, I will participate in the Camp/Venture Out! program and follow all the rules.  I understand that the use of possession of tobacco, illegal drugs and/or alcohol will result in my immediate dismissal from camp.  I will not bring a cell phone or other communication device.

Camper's Signature _______________________________________Date      /      /       .

PARENTS:  Please read and sign the following statement:

In case of emergency, I give permission for the staff of Camp McDowell to select a physician and seek medical treatment for my child.  I give permission for my child to receive over the counter medication from the camp nurse following physician guidelines.  I understand that if my child participates in Venture Out!, he/she will be treated by the Venture Out! staff.  I give permission for photographs of my child to be used for promotional purposes by Camp McDowell.  I understand that I am financially responsible for property damages caused by my child's behavior.

Parent's Signature: ______________________________________Date      /      /       .

To request a scholarship, please contact Michael Goldsmith at (205-387-1806) or (michael@campmcdowell.com).
Please consider making a contribution to the Camp McDowell Scholarship Fund when paying your registration fee.
A Photo CD is available for each camp session at a cost of $10. Please add this to your registration fee.

Canteen money may also be added to your registration fees. $2.50/day is usually sufficient. Please indicate on the memo line of your check if money has been added to your registration fee for Scholarship Fund Donation, Canteen, or Picture CD.
T-shirts will be available for purchase on the opening and closing day of each session.
At the end of the session, if your child has left over canteen money, would like to donate it to the
Camp McDowell Scholarship Fund? Yes / No (please circle)