DATES FOR 2019 - Holy Cross Young Church
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Plans are underway for the 24th
annual awesome, multi-parish,
4 day/3 night summer Camp
WOW! The cost is $260.00 per
camper. Due to the limited number
DAT E S F O R 2 0 1 9 of camper spots available, camp is
filled on a first-come, first served
basis and limited to families
registered at Corpus Christi.
If needed, a limited number of
scholarships will be available.
Call the youth ministry office ASAP
to inquire.
1. Registrations, medical forms, and a $60
non-refundable deposit will be accepted
beginning November 2018.
2. Anyone accepted to camp is committing to
be there for the entire event—no
exceptions.
3. Deposit is non-refundable. $200 Camp
fee is non-refundable after June 1st.
Join us for 4 days of: What is CAMP WOW?
• MASS It’s a 4-day, 3-night summer camp for
• ADORATION middle school students sponsored by
several area parishes.
• SWIMMING
When is WOW?
• PRAYER
Wednesday, June 12—Saturday, June 15
• ARCHERY
Who can go?
• BIBLE STUDY
Any Corpus Christi youth currently in
• CAMPFIRE
grades 6th, 7th, or 8th
• INDOOR GYM
Where is it held?
• CLIMBING WALL
Dickson Valley Camp & Retreat Center
• HIKING in Newark, IL (Near Plano, IL)
• SPORTS How much is it?
• MUSIC $260.00* (Includes the $60.00 deposit)
• SKITS *NO ONE WILL BE DENIED
• CRAFTS PARTICIPATION BECAUSE OF AN
INABILITY TO PAY.
• AND SO MUCH MORE!
SOUNDS FANTASTIC!! How can I register?
1. Fill out the registration form and medication forms and return both with your
$60.00 non-refundable deposit (payable to Holy Cross Catholic Church, 2300
Main Street, Batavia, IL 60510 (ATTN: Camp WOW!) The balance of $200.00 is
due no later than April 12, 2019.
2. Failure to pay by the required dates will result in the loss of your space at
camp (Unless other arrangements have been made in advance).
QUESTIONS?
Call Michael Bone at ccym1415@gmail.com or 630-483-4226
REGISTRATION OPENS DECEMBER 2018.
SPACES WILL BE FILLED ON A FIRST-COME, FIRST-SERVE BASIS.
CAMP WOW 2019—REGISTRATION & PERMISSION FORM
GENERAL PERMISSION FORM MEDICAL PERMISSION FORM
I request that my child ,______________________________, be allowed I grant permission for the administration of First Aid to my child,
to participate in Camp WOW located at Dickson Valley Camp, Newark, IL _____________________________________, by the people in charge of Camp
on the following day(s): from June 12, 2019 to June 15, 2019 I hereby WOW, and those transporting my child to and from the event as their judgment
release and indemnify Corpus Christi Church, Holy Cross Church, and St. deems advisable, and to make the necessary referrals to qualified physicians for
Peter Church, their staff, volunteers, and the Catholic Bishops of Dioceses the treatment of illness or accidents of a more serious nature. I understand I will
of Joliet and Rockford from any and all liability arising from claims of any be promptly notified in the event of any serious illness or accident and prior to any
kind or nature whatsoever from my child's participation in this event. major surgery, except when delay in such communication would endanger life. In
Campers are expected to stay during the entire camp session and if they the case of a medical emergency, I understand that every effort will be made to
must leave for any reason other than a family emergency they should not contact the parent/guardian of the participant. In the event that I cannot be
register for camp. reached, I hereby give permission to the physicians selected by the adult staff to
Videotaping and Still Photographs hospitalize, secure proper treatment for, and to order injection, anesthesia, or
surgery if deemed necessary for my child.
Video and still photographs may be taken during this event. This
authorization form constitutes permission for my child's participation in the (PLEASE PRINT NEATLY)
videotape and/or still photographs, which may be used for future
promotional efforts, including the church website, ministry Facebook, and Camper’s Name:______________________________________
social media pages but is not limited to these.
Code of Behavior Address:____________________________________________
You are representing Youth Ministry in our diocese during this event and ___________________________________________________
we expect you will represent us well. We expect that you will display
mature and responsible behavior, which for many years has been the
trademark of Catholic youth and adults of our diocese. Birth Date: __________________________________________
Some Expectations:
1. All participants are expected to arrive on time to all events. School:_____________________________________________
2. All participants are expected to demonstrate common courtesy and Grade as of Sept. 2018:________________________________
respect at all times. Inappropriate language/behavior will not be
tolerated.
3. Socializing should always be done in designated public areas.
T-SHIRT SIZE: (ADULT SIZES) S M L XL XXL
4. Dress should reflect the value of modesty. Writing on clothing should
reflect Christian values. Parent’s Name (s):
5. The possession or consumption of any alcoholic beverage and/or ____________________________________
possession/use of any illegal drug is not permitted.
6. Smoking is not permitted. (this includes E-cigarettes). Phone #: (_________) _____________________________
7. Weapons and/or drug paraphernalia are not allowed. (circle) mother’s / father’s — (circle) home / work / mobile
8. All medications, including over the counter (i.e. Tylenol, aspirin,
Benadryl, etc.), are to be turned in to the camp nurse upon registra-
tion. Medication should be in its original container and clearly marked Phone #: (_________) _____________________________
with the young person’s name. Please put the containers in a clear (circle) mother’s / father’s — (circle) home / work / mobile
zip-lock bag along with instructions indicating dosage amounts and
times.
EMAIL:_____________________________________________
9. Infraction of these rules can mean immediate dismissal with no
refund. Participants will be responsible to local authorities as well.
I understand and agree to this Code of Behavior. I also understand
Insurance Information
and agree that at the time of an infraction requiring my dismissal, I Policy in the name of __________________________________
am responsible for my removal from the premises and any costs Insurance Company: __________________________________
involved.
Policy Number: ______________________________________
Authorized Physician: _________________________________
I also understand and agree that my parents or guardian will be
notified at the time of an infraction requiring my dismissal. My Phone #: _______________________________________
parents or guardian will be responsible for my removal from the
premises and any costs involved. Office Use Only:
$60 Deposit Pd.: ___________
Camper Signature:_____________________________________ Date_______ Medication Form.:___________
$200 Balance Pd. __________
Parent Signature: ______________________________________Date_______
Scholarship Gift: $_________
*We are in need of additional funds to help give financial assistance to families who
would like to send their kids to camp, but can’t afford the fee. If you would be able to help it would be greatly appreciated!
Return this completed form, the medication form, & $60 deposit to starting December 2018. Space can fill up quickly. Checks
need to be made out to Holy Cross Catholic Church. No one will be denied participation because of an inability to pay. If you anticipate any difficulties paying for
camp, please call the Youth Ministry office.
ALL MEDICATION FORMS ARE DUE AT TIME OF REGISTRATION
(PLEASE UPDATE AS NEEDED PRIOR TO CAMP)
The following policies have been put in place for the safety and well-being of all
campers, counselors, volunteers, and staff of Camp WOW.
REGARDING ILLNESS
1. If your child is ill anytime within 7 days prior to Camp beginning, we ask that they
not come to camp per the Centers for Disease Control recommendations for
summer camps.
2. If your child has a temperature over 99.5 during camp we will ask you to bring
them home.
3. If your child is sent home due to illness during camp we ask (for the safety of
others at camp) that your son or daughter not return to camp.
REGARDING MEDICATION:
1. A registered nurse will be at camp the entire time. Only the registered camp nurse
will dispense medications to campers or counselors.
2. Only medications indicated on the attached medication form and provided by the
parents will be dispensed to campers or counselors.
3. All prescription medications must be in the original containers and have parent’s
and physician’s signature on the medication form in order for the campers or
counselors to be given medications.
4. You are required to indicate on the attached form what OTC meds are
approved for your camper or counselor, regardless of whether or not you
believe they will need medication during the camp. DO NOT LEAVE IT
BLANK. All over the counter medications (i.e. Tylenol, Motrin, Benadryl, etc.)
must be in the original containers and must have permission to dispense indicated
on the medication form.
If medications change before camp begins, please submit a new medication
form or addendum to original form indicating changes. Please date and sign
every form. MEDICATION FORM IS DUE AT TIME OF REGISTRATIONCAMP WOW 2019 STUDENT MEDICATION FORM—PLEASE PRINT NEATLY
*ALL STUDENTS MUST HAVE THE OVER-THE-COUNTER MEDICATION SECTION COMPLETED ON THIS FORM. DO NOTE LEAVE IT BLANK (no exceptions).
Also, form must be signed BY PARENT & PHYSICIAN (for prescription medication) before medications will be given.—USE EXTRA COPIES OF FORM IF NEEDED
Child’s Full Name_____________________ D.O.B._____ Emergency Contact:_________________________
Parent Names:___________________________________ Phone #__________________________________
Parent Phone #’s ________________________________ Allergies:_________________________________
Over the Counter Medications & Dosages (MUST BE COMPLETED)
You must send OTC medications with child in original containers labeled with camper’s/counselor’s name.
Tylenol/Acetaminophen Benadryl Ibuprofen(Motrin)
dosage dosage dosage
Advil Other
dosage name of medication / dosage
OTC Administered date/time/dosage _______________________ ___________________________
My child has permission to carry epi-pen inhaler
Parent Initials________ Administered (date/time/dosage)_______________________________
Prescription Medication & Dosages *Use another form if more RX medications are needed
This Side To Be Completed By Physician if Prescription meds. THIS SIDE FOR NURSE USE ONLY
Time Date Date Date
Name of Medication:_______________________ A.M.
Dosage:___________________________________ Noon
Time Taken:_______________________________ P.M.
This Side To Be Completed By Physician if Prescription meds. THIS SIDE FOR NURSE USE ONLY
Time Date Date Date
Name of Medication:_______________________ A.M.
Dosage:___________________________________ Noon
Time Taken:_______________________________ P.M.
You must send prescription medication with child in original containers labeled with child’s name.
Notes:_______________________________ Parent Signature*______________________
_____________________________________ MD Signature+________________________
+For prescription medications only
_____________________________________ DATE:______________________________
*Form must be signed by a parent for any medications to be distributed to campers or counselors.Camp WOW 24
Dickson Valley Camp & Retreat Center—Newark, IL Wednesday June 12, 2019 through
Saturday June 15, 2019
Student Name:
*This permission slip also gives my consent for Camp WOW and the parishes involved with camp to take
pictures, video, etc. of event that may or may not include my child and use said resources in various print
and social media venues for promotion of future events.Email address (for event updates, etc.): ______________________________________________________________ (parent)
______________________________________________________________ (student)Camp WOW 2019
Dickson Valley Camp, Newark, IL Camp WOW 2019
06-12-19 06-15-19
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