2017 Annual Conference -- Youth Camp and Childcare Registration

Deadline for registration is May 8, 2017. No registrations for child care will be accepted after this date.

Contact First Name
Contact Last Name
Contact Email
*Parent's Daytime Phone Number
Child/Youth Registration
Information To register more than one child, click Additional Registrant. Be sure to answer each question for each child.
*First Name *Last Name *Address 1 *City *State *Zip *Email
*Age
*Gender
Male
Female
*Grade in 2017-2018

Please enter the grade level your child or youth will be entering in the 2017-18 school year

*Birthdate
*T-Shirt Size

Shirt sizes are Y-XSM (2-4), Youth: YSM (6-8), YMED (10-12), YLRG (14-16), Adult: ASM, AMED, ALRG, AX-LRG

Y-XSM (2-4)
YSM (6-8)
YMED (10-12)
YLRG (14-16)
Adult Small
Adult Medium
Adult Large
Adult X-Large
Special Needs Please indicate any special needs for your child(ren).
*Registration fee

For the first child, please select the first child option. Each additional child, please select "Additional Child" option. Please help us prepare by pre-registering your children. There are no walk-in registrations for child care.

First child registration fee ($85)
Additional child registration fee ($50)
Additional child registration fee ($50)
Additional child registration fee ($50)
*Photograph Authorization By clicking YES, I hereby giving my approval for photographs to be taken during Annual Conference which may be used by the IGRC.
Yes
No
Hours of Operation
*Time Period of Attendance

Because adequate personnel are needed for the number of children/youth in attendance, please indicate when your child will be in attendance. By checking the assigned times, you are making a commitment that your child will be attending. Be sure to select "Additional Child Option" and mark for each child you are registering.

Thursday 8 a.m. to 5:45 p.m.
Thursday 6:30 to 8:45 p.m.
Friday 8 a.m. to 5:45 p.m.
Saturday 8 a.m. to adjournment
Meals

Lunch and snacks are provided for the children and youth. You are responsible for providing breakfast and for picking up your child and youth promptly for dinner. All participants will receive a t-shirt, water bottle, and sling bag with registration.

Menus for Thursday and Friday lunch are as follows:

Thursday: Grilled cheese (cut into fourths), tater tots, pudding cups, milk

Friday: Macaroni and cheese, carrots, Jell-o cups, milk

Items Needed
Please bring and label the following items for your children and youth:

Younger children (6 months to kindergarten): Blanket to nap on, food or bottle, if they have special dietary needs, change of clothes, diapers, if needed, with their names on them. This group stays on the Civic Center grounds.

Older Children (Kindergarten through 8th Grade): Swimsuit (without snaps or zippers) and towel, extra change of clothes if needed, food, if they have special dietary needs. On Thursday and Friday, this group travels to East Bay Camp. On Saturday, they have a special activity still to be announced.

Youth (High School): Swimsuit (without snaps or zippers) and towel, extra change of clothes if needed, food, if they have special dietary needs. This group will attend East Bay as Counselors as well as the special activity on Saturday. On Friday evening, this group will have a special outing of their choosing.
Confirmation and Contact Information
Registration confirmation will be sent via email following the final registration deadline.

For more information, contact Nancy Henson at 618-830-7061.
Children and Youth Emergency Permission and Health Slip
*Consent to Seek Medical Attention By clicking YES, I give my permission for Annual Conference Child Care volunteers to seek medical attention, if observation or medical treatment is urgent for my child.
Yes
No
*Hospitalization Insurance Coverage Answer whether the child is covered under hospitalization insurance.
Yes
No
If YES to Hospitalization Coverage Please provide the name of the insurance, the policy number and the name of the insured.
*Annual Conference Lodging Please give the location of where you will be staying during Annual Conference
*Cell Phone or Pager Number During Annual Conference
Secondary Emergency Contact
If unable to be reached, please indicate who should be contacted as a secondary contact person.
*Name
*Relationship to the Child
*Location and Phone Number
Medical Conditions/Allergies/Special Needs Please list any medical conditions/allergies/special needs. Please arrange, if possible, for medication to be dispense by parents. Please include food allergies. Also indicate if your child has ear problems that could be affected by swimming or other forms of allergies.
*Approved Pick-Up Persons I give permission for the following person(s) to pick up my child (make sure to include yourself).
Well Child Policy

Child care will not admit a child if he/she has any of the following: diarrhea, fever 100 or higher with symptoms of other illness, known contagious disease, questionable rash, vomiting, conjunctivitis or a severe cough/cold.

If a child is on antibiotics, he/she should have been treated at least 24 hours before admittance to child care.

If a child becomes ill and the illness prevents the child from participating comfortably in activities as determined by the child care provider or the illness results in a greater need for care than child care can provide without compromising the health and safety of the other children as determined by the child care provider, parents will be notified and the child will need to be removed from child care.

Upon notification of a sick child, the parent(s) will come immediately to pick up his/her child. In case of a serious emergency, appropriate emergency personnel will be contacted as well.

Re-admittance into child care following an illness while at Annual Conference will be at the sole discretion of the head of child care and must adhere to numbers 1 and 2 of the stated policy. A doctor's note granting permission to return to child care is highly encouraged.

*Agreement to Well Child Policy By clicking YES, you are agreeing to comply with the stated Well Child Policy.
Yes
No

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