2019 Annual Conference -- Youth Camp and Childcare Registration

Deadline for registration is May 6, 2019. No registrations for childcare will be accepted after this date, and there are no onsite registrations for childcare.

*Parent's Daytime Phone Number
Information To register more than one child, click Additional Registrant. Be sure to answer each question for each child.
Who is filling out this form?
First Name
Last Name
Who are the participants?
*First Name *Last Name *Address 1 *City *State *Zip *Email
Child/Youth Registration
*Grade in 2019-2020

Please enter the grade level your child or youth will be entering in the 2019-20 school year

*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

Youth X-Small (2-4)
Youth Small (6-8)
Youth Medium (10-12)
Youth Large (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 ($75)
Additional child registration fee ($45)
Additional child registration fee ($45)
Additional child registration fee ($45)
*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.
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.
*Children of the Annual Conference will sing Friday at 5:10. 


Thursday 8:30 a.m. to 5:45 p.m.
Thursday 6:45 p.m. to 8:45 p.m.
Friday 8:00 a.m. to 5:45 p.m.
Saturday 9:00 a.m. to 12:15 p.m.

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: Macaroni and cheese, carrots, Jell-o with fruit cocktail, milk

Friday: Grilled cheese (cut into fourths), tater tots, pudding cups, apple juice


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 and Older): Swimsuit (without snaps or zippers) and towel, extra change of clothes if needed, and 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.

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.
*Hospitalization Insurance Coverage Answer whether the child is covered under hospitalization insurance.
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.
*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 dispensed by parents. Please include food allergies. Also, please indicate if your child has ear problems that could be affected by swimming.

*Approved Pick-Up Persons

I give permission for the following person(s) to pick up my child (be sure to include yourself).

Well Child Policy

Childcare 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 childcare.

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

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

*Agreement to Well Child Policy By clicking YES, you are agreeing to comply with the stated Well Child Policy.
Your browser is not supported or has JavaScript turned off. To register use a different browser or turn on JavaScript.