2014 Timothy Project Registration


2014 TIMOTHY PROJECT
August 24-29, 2014
Come join a limited group of youth aged 14-18 for an in-depth study of servant leadership, spiritual training, mentoring, and inclusion in on-site service projects. This is Salem Acres' chance to re-invest in our youth, receive feedback about camps and help kids transition back into life with their family, community, and school.

This camp has a limited enrolment. All applicants may not be accepted into the project. Please submit one form for each applicant.
Cost of registration is $115.00 for the week.
Required fields are indicated by *

CAMPER'S PERSONAL INFORMATION

First Name	*
Last Name	*
Mailing Address	*
City/Town	*
Province	*
Postal Code	*
Email Address	*
Home Phone #	*
Daytime Phone #
Cell Phone #
Gender	*	Male Female
Birthdate	*
Provincial Health Insurance #	*
Grade entering in Fall 2014
Have you attended a SABC camp before ?	*	Yes No
T-Shirt size	*	Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult Extra Large

Why would you like to attend the Timothy Project?	*
What would you like to learn from the program and why?	*
Describe what you think servant leadership means? Can you provide a Biblical example?	*
What is the most important quality of a servant?	*
What is the most challenging aspect of servanthood?	*
What motivates you to serve at camp?	*
Do you have a spiritual role model (other than Jesus)? If so, who? And why?	*
How much effort are you willing to put into learning about servant leadership?	*
PARENT/GUARDIAN INFORMATION

First Name	*
Last Name	*
Relationship to camper
Email Address
Contact Information the same as the camper?	*	Yes (Skip the following contact info) No (Fill in the following contact info)
Mailing Address
City/Town
Home Phone #
Daytime Phone #
Cell Phone #

EMERGENCY CONTACT INFORMATION

In case of an emergency, the person we should contact if the Parent/Guardian is unreachable:

Full Name	*
Phone #	*
Additional Phone #
Relationship to Camper	*

MEDICAL INFORMATION

Will the camper be taking any medication while at camp? If so, please describe the dosage and frequency.	*
If any medication is to be taken on a regular/semi-regular basis, the parent/guardian is responsible for ensuring that the appropriate medication is sent with the camper. ALL medication is to be given to the camp nurse with written instructions upon arrival at camp. Medication of any kind is NOT permitted to stay with the camper while they are at Salem Acres. All medication should be picked up form the camp nurse by a parent/guardian on the last day of camp when you come to collect your child.
Does the camper have have any allergies or has the camper ever reacted to any animals, foods, medications, environmental products or anything else? If yes, please describe the reaction and how the camper treats the allergies at home. Does the camper use antihistamines? If so, how often?	*
Does the camper have any type of disability (mental, emotional or physical) that could affect the camper's degree of participation in any activity?	*
Are the camper's immunizations (e.g., tetanus) up to date? Please provide details.
Do you give SABC and its staff permission to administer non-prescription medications (such as Tylenol, Gravol, cough medicine, Benadryl, etc.) when needed and as directed?	*	Yes No
Is there any other information that you think we need to know about the camper?	*
Total Cost of Registration		115.00

CONSENT

By filling in your name below, submitting this form, sending the child to SABC or attending a camp, you agree to the following statements:
1. Medical - I give SABC and its staff members the permission to proceed with emergency medical treatment, and may authorize medical personnel to proceed with treatment.
2. Liability - I will not hold SABC, its staff members or volunteers liable for any accident in which loss or damages occur. I waive the right to proceed with any and all actions against SABC, its staff and volunteers for any incident, including those caused by negligence.
3. Use of Photos – I give SABC permission to use photos taken during camp by SABC staff and volunteers for promotional purposes.
Parent/Guardian (or Camper if 18 or Older) Consent
Do you give Consent?	*	Yes
Full Name	*
Today's Date	*