REGISTRATION PACKET - Missouri Baptist ...
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REGISTRATION PACKET
This packet includes the following:
INTRODUCTION LETTER
DATES & CAMPUS INFORMATION
PRICING DETAILS
THE MUST READ LIST
REGISTRATION/ORIENTATION PROCEDURE
RULES
TENTATIVE SCHEDULE/PACKING LIST
CONTACT PERSON FORM
SPONSOR RECRUITMENT
CAMPER SAFETY INFORMATION
SPONSOR BACKGROUND CHECK FORM
STUDENT & ADULT REGISTRATION FORM
MEDICAL RELEASE FORM
HLGU WAIVER
CHURCH ROSTER/ROOMMATE PREFERENCE FORMS
Missouri Baptist Convention • 400 East High Street • Jefferson City, MO 65101 • 800.736.6227
A ministry made possible through the Cooperative Program.Dear Youth Leader,
Thank you for your interest in Super Summer 2021. We know it has
been a challenging year. In light of the ongoing COVID-19 pandemic
we have had to make some major changes to Super Summer this year.
Traditionally we have had two weeks of camp, but this year we are
splitting each week into two sessions. We are also limiting the number
of people who can be on campus for each session to half the normal
numbers. For example, we can house a little over 500 on campus at
HLGU, but we are limiting each session there to 250. This will allow us to
better maintain safety and health protocols. We will be adjusting these
protocols as the situation with COVID-19 continues to evolve in the
months leading up to camp.
Another change we have made to camp this year is we will not be splitting students up into
teams based on their grade (i.e. 6th & 7th grade was Red Team, etc.). Instead, we are going to
keep students together with their church group throughout the day and have them move from
one thing on the schedule to the next as a church group. This will necessitate church leaders
staying with their students throughout the day and serving as their group’s small group leaders.
We believe this will help us maintain safety and health protocols better.
Super Summer is for students who have completed 6th-12th grades. Super Summer is designed
to help introduce students to Jesus Christ, encourage them in building relationships with other
believers, and equip them to grow in their faith. You will feel comfortable bringing any student
regardless of where they are in their journey with Christ. Super Summer will be a great place for
students who are just beginning to investigate Christianity, students who are new in their faith, and
students who are mature and ready to go deeper. Your students will be sitting under the teaching
of some incredible leaders during the week of Super Summer, both during the team times and
the evening worship times.
We expect the maturity necessary to participate in Super Summer in accordance with the
rules you will find in this packet. Please make sure you communicate these to your students clearly
and know that we will be depending upon you to see that this happens. Super Summer is going
to be a fun opportunity for your students. However, our greatest purpose is to help them grow
deeper in a relationship with Jesus Christ!
Thank you again for making plans to be with us at Super Summer. We look forward to seeing
you there and are expecting God to do great things in the lives of your students. Please pray
with us to that end!
For Jesus, Questions?
Contact Jason Walters at
Jason Walters & the Making Disciples Group (MDG) jwalters@mobaptist.org
or
314-640-7984
Missouri Baptist Convention • 400 East High Street • Jefferson City, MO 65101 • 800.736.6227
A ministry made possible through the Cooperative Program.DATES & CAMPUS INFORMATION
Dates: Session 1: June 13-16, 2021 Session 3: June 20-23, 2021
Session 2: June 16-19, 2021 Session 4: June 23-26, 2021
at at
Hannibal-LaGrange University Southwest Baptist University
Campus 2800 Palmyra Road 1600 University Avenue
Address: Hannibal, MO 6340 Bolivar, MO 65613
Campus (573) 221-3675 (417) 328-5281
Phone:
Directions: For directions, please contact the campus directly or Google® directions using the
above address.
Telephone: Super Summer requests that calls be limited to emergency calls only. Should the
students need to contact family members on a daily basis, each dormitory is
equipped with phones for the students to use. However, incoming calls to Super
Summer need to be limited to emergencies only. An emergency would include
severe family illness or death. Calls about travel arrangements, etc., should be
unnecessary. All arrangements need to be taken care of prior to Super Summer.
In case of emergency during the week of Super Summer, call:
Jason Walters (314) 640-7984
Housing: All Super Summer participants will be housed in on-campus dormitories at each
week of camp. All participants in Super Summer will be housed according to their
gender at birth. Adults will be housed with other adults and students with other
students as much as possible. Adults, do not plan on coed housing with your spouse.
Room assignments will be made on a first come/first served basis with individuals
within church groups assigned as close together as space permits. PLEASE DO NOT
ASK FOR SPECIAL HOUSING CONSIDERATIONS unless there is a health problem. If you
did not include a note with your registration explaining your need, please contact
the Super Summer office right away at (573) 636-4000, ext 365.
Accessibility: Please understand that participation in Super Summer will involve a moderate level
of physical activity, including quite a bit of walking. If there are any questions about
accessibility, please contact the Super Summer office at (573) 636-4000, ext. 365.
Meals: Meals for sessions 1 & 3 will begin with supper on Sunday and conclude with
breakfast on Wednesday. Meals for sessions 2 & 4 will begin with supper on
Wednesday and conclude with breakfast on Saturday. If you or your students have
food allergies or are on a strict diet as prescribed by a physician, please contact us
ASAP, and we will do our best to accommodate your needs.PRICING DETAILS
We are changing pricing for Super Summer 2021 to a flat rate for students and adults.
• Regular Registration Rate: $195/student
o $50 deposit
o No registrations can be taken after 4:00pm on June 7, 2021
• Adult Leader Rate: $140/adult
o $50 depositMUST READ LIST
• ONLINE REGISTRATION
Online registration for Super Summer 2021 will begin on April 1, 2021. The entire registration
process can be done online this year. More info on the next page. We have limited space
for each week of camp and once the limit has been met, the system will not allow any more
registrations for that week. Therefore, you need to be mindful of the registration deadlines.
• PAYMENT
Deposits and payments made in full may be made online by credit card/debit card or by
mailing a check. (Note: DO NOT send cash.). If mailing a check send to the attention of Super
Summer. Any remaining balance (paid with check, or credit card) should be brought with
you to Super Summer.
• CONTACT PERSON FORM
Only ONE Contact Person Form needs to be submitted for each church group attending Super
Summer. The Contact Person needs to be someone who will be attending Super Summer with
your students (i.e. not the church pastor if he is not coming).
• REGISTRATION FORMS
Every student and leader (anyone who is attending Super Summer) must complete a
Registration Form, Medical Release Form, and HLGU Waiver (only necessary for those
attending Session 1 or 2 at HLGU). Incomplete forms will not be accepted.
- DO NOT submit Medical Release Forms without a Date of last tetanus shot. “current” and
“don’t know” are not acceptable. If we take your student to the hospital we must have a
date. “Not Current” is acceptable.
- DO NOT submit Medical Release Forms without the requested insurance information.
Students and adults are not required to have medical insurance to attend Super Summer.
If a student or adult does not have insurance, please check “No” on the bottom portion
of the Medical Release Form.
• SPONSOR BACKGROUND CHECK FORM
Every sponsor who attends Super Summer with your group must have a background check
on file at the church. This form verifies that all sponsors coming with your group have been
background checked. You will also need to bring a copy of the background check report for
every sponsor with you.
• CHURCH ROSTER
All students and adults from your group must be listed on the Church Roster/Roommate
Preference Form. This form also serves as the Roommate Preference Form. Everyone from your
group needs to be on your list. All individuals attending Super Summer will be housed
according to their gender at birth. NOTE: there are separate forms for SBU and HLGU.REGISTRATION PROCECURE
ONLINE REGISTRATION:
Here is the process for Online Registration:
1. Online registration will open on April 1, 2021. In order to register
your group online you will need to have completed registration
packets including all forms filled out and signed (by parents)
(registration, medical release, roster forms, copy of insurance
cards etc) for all students and adults who will be coming with
your group. Anything that you used to send in the mail can now be submitted online. A
$50 deposit is due at the time of online registration. (You can use a credit card or mail a
check for this). If you choose, you can pay the entire registration balance at the time of
online registration. Register yourself as the leader of your group first and at the end of each
registration you have the option to “add another” to your group.
2. No registrations, changes, or additions will be accepted after June 7, 2021.
ON-SITE REGISTRATION:
The Contact Person (or representative) will come to the central registration table to pick up their
group’s registration packet and pay the balance for their group. The Contact Person (or
representative) should have a copy of their Sponsor Background Check Form, file with
background check reports, Church Roster/Roommate Preference Form, and all medications in
hand (all meds to be turned in to Super Summer Nurse). Materials, t-shirts, and lanyards will be
given out at the registration table. After picking up the group’s registration packet, the Contact
Person will then proceed to the room key table (located in the same area) to pick up room keys
from the campus representatives.
REGISTRATION TIMES: Churches’ registration times will be assigned alphabetically according
to the city your church is from. Registration times are as follows:
Cities beginning with A – K will register starting at 2:00 p.m. on Sunday or Wednesday.
Cities beginning with L – Z will register starting at 3:00 p.m. on Sunday or Wednesday.
Once the Contact Person has picked up their registration packet, he/she will distribute materials
and room keys to students and accompany them to their respective dorms. Participants arriving
at the dorms will be greeted by small group leaders who will help unload their luggage.
After vehicles are unloaded, students are free to get settled into their rooms. They should return
to main auditorium by 3:55 p.m. for Orientation.
ORIENTATION:
There will be ONE orientation session for all participants, adults, and students. Orientation will be
held at 4:00 pm in the Pike Auditorium at SBU and in the Roland Fine Arts Center (RFAC) at HLGU.
All Super Summer attendees must attend orientation. ORIENTATION IS NOT OPTIONAL!
You will go to dinner, as indicated on the 2021 schedule, immediately following Orientation.
Remember your first Team Meeting begins at 6:15 PM. Don't be late!RULES All participants and their parents/guardians must be aware of the expected order of conduct for Super Summer. Failing to adhere to the following rules could result in the student’s early dismissal from Super Summer at the church/parent/guardian’s expense. 1. Every participant is required to attend Sunday-Wednesday, or Wednesday-Saturday of the session registered. Late arrivals or early check-outs are not permitted. 2. Students are not allowed off campus. No student is allowed to leave the campus at any time with anyone. Once the student is registered, they MAY NOT leave campus until check- out time on Friday. 3. Every church sending students must have at least TWO adult sponsors attending, one male and one female. 4. Students are not allowed to ride in or on any vehicle. Students and small group leaders will walk everywhere while at Super Summer. All cars, vans, and buses must be parked and not used from Monday’s registration through Friday’s final session. Those with personal needs should consult their Team Leader. 5. Students must attend all sessions. Late arrivals to, early departures from, or other activities/meetings during Super Summer are not permitted for anyone for any length of time. Every student is required to attend every session. 6. Students must go straight to their classrooms and leave the building when each session is completed. Remember, Southwest Baptist University and Hannibal-LaGrange University are institutions of higher learning conducting summer classes and regular business affairs. We must be sensitive to their needs. 7. Students must be in the dorms and have lights out at the assigned times. Breaking curfew at Super Summer is unacceptable for anyone – including adults. 8. Drugs, alcohol, any form of tobacco, firearms, weapons, or any fireworks are not permitted. Students possessing these at Super Summer will face potential criminal charges from campus security and be sent home. 9. No electronic device of any kind (except a basic alarm clock), and water guns are not allowed. They will be confiscated or held by the youth leader and NOT returned until students leave on Friday. 10. Students must dress appropriately. If your clothes are a distraction to yourself or others, you will be asked to change. The following items are permissible to wear: anything that is discrete & proper for a Christian environment including, but not limited to, shorts, jeans, khaki/dress pants, t-shirts, polo & button down shirts. The following items are not permissible: tight or form fitting clothing of any kind, sleeveless or cut-off shirts, halter or tank-tops, anything with spaghetti straps, muscle shirts, shirts with any alcohol or tobacco or questionable slogans or bands, and shorts/pants with writing on the back. 11. Any form of Public Displays of Affection (PDA) is not allowed. 12. Ordering food to be delivered on campus is forbidden. 13. Under NO circumstances are girls to be near or in the guys dormitories or vice versa. 14. Students must wear lanyards at all times. There will be a replacement fee of $5.00. 15. Students must keep track of room keys and key cards. Lost keys will cost $25.00 to replace. Lost key cards will cost an additional $50.00 to replace. The church leader attending Super Summer with his/her students is responsible for the keys checked out by his/her students. Payment MUST be made by the church leader at time of checkout for all lost keys. No exceptions. 16. Students who are injured or ill should contact the Super Summer nurse immediately. The nurse is responsible for diagnosing illness, not your roommate. 17. Churches are responsible for damage to campus/facilities. Because the University holds Super Summer responsible for all damages, any damage or loss will be the responsibility of the churches involved. If no admission of guilt is made regarding dorm room damage, each party in the room will be billed an equal portion of the cost of repair by the church. A letter/bill will be sent following Super Summer. 18. Students are to stay in rooms assigned. Students are responsible for damages to room assigned. Changes must be approved by Super Summer office. No exceptions. Your cooperation is vital with hundreds of students and adults involved in a week of activities. We want the best for each participant this week. We want SUPER SUMMER to be the greatest five days of your life. YOUR HELP in accomplishing this goal by following these rules and making us aware of any special needs will be greatly appreciated. 19. Zero tolerance for any forms of sexual harassment or abuse. Any individual found engaging in inappropriate sexual behavior will be reported to campus security who will process the investigation.
TENTATIVE SCHEDULE
Sunday/Wednesday
2:00-4:00 Registration/Move-in 3:00-4:30 Recreation
4:00-4:30 Orientation Or
4:30-5:45 Dinner Bible Study
6:15-7:45 Bible Study 4:45-6:00 Dinner
8:00-10:00 Evening Worship 6:00-7:00 Discussion Time
10:00-10:30 Church Group Time 7:00-9:30 Evening Worship
11:00 In Dorms 9:30-10:15 Church Group Time
11:30 Lights Out 11:00 In Dorms
11:30 Lights Out
Monday-Tuesday/Thursday-Friday
7:15-8:15 Breakfast Wednesday/Saturday
8:15-10:30 Bible Study 7:30-8:30 Breakfast
10:30-11:30 Morning Show 8:30-9:00 Pack/Clean
11:30-12:00 Lunch 1 9:00 Go home/See you next year!
12:00-12:30 Lunch 2
1:00-2:45 Bible Study
Or
Recreation
PACKING LIST
Students and Leaders will need to bring the following items:
• Bible, journal or notebook, and a writing utensil
• Clean clothes – see #9 on the Super Summer Rules form for dress code
• Bedding – pillow, sleeping bag or sheets & blanket, etc.
• Towels, washcloths, personal toiletries, and all other basic essentials for a week away
from home
• Please see #8 on the Super Summer Rules form regarding electronic devices
• All students are encouraged to bring at least one set of old clothes for some of the
activities. There may be messy games during the week! No white shirts for games
(colored shirts only). If you get wet, we don’t want to see under your clothes!!!
• FACIAL MASKS, we are going to ask everyone to remain masked while indoors or in
close contact with others. Obviously masks will not be required while eating,
showering, or sleeping.CONTACT PERSON FORM
CHURCH NAME ______________________________________________________________
CHURCH PHONE (__________)_________________________________________________
CHURCH ADDRESS__________________________________________________________________________
CITY_________________________________________________ STATE ___________ ZIP _________________
CONTACT PERSON__________________________________________________________________________
ADDRESS ___________________________________________________________________________________
CITY_________________________________________________ STATE ____________ ZIP _________________
HOME PHONE (_________)_____________________ WORK PHONE(_________)______________________
EMAIL ADDRESS _____________________________________________________________________________
SESSION YOUR GROUP PLANS TO ATTEND:
_________ Session 1: June 13-16, 2021 _________ Session 2: June 16-19, 2021
Both sessions at Hannibal-LaGrange University, Hannibal, MO
_________ Session 3: June 20-23, 2021 _________ Session 4: June 23-26, 2021
Both sessions at Southwest Baptist University, Bolivar, MO
All Registration/Medical Release Forms, campus waviers, and deposits must be in the Making
Disciples Group office by 4:00 p.m. on Monday, June 7, 2021. NO REGISTRATION CHANGES WILL
BE ACCEPTED AFTER JUNE 7, 2021.
Please send all forms and deposits to:
Missouri Baptist Convention
Attn: Super Summer
400 East High St.
Jefferson City, MO 65101
It is required for each church to have at least one male and one female sponsor. We also
recommend one sponsor for every 5 students.
I verify that all forms are complete and correct. I also understand that only students who are able
to attend the whole week of camp will be allowed to participate, and no late arrivals or early
departures are allowed.
Signature___________________________________________________________Date___________________SPONSOR RECRUITMENT
CONTACT PERSON
Each church is required to appoint a CONTACT PERSON. The
contact person is responsible for the group and serves as the
point of contact with Super Summer staff during the week. This
person is typically the youth pastor, senior pastor, or lay person
(only in the absence of a youth minister or pastor) designated as
the youth leader at their church.
SPONSOR SELECTION
Sponsors set the tone for the week. If a sponsor has a great attitude, students will have a
great week at camp. If sponsors are godly role models and use their influence wisely for
the Kingdom, there will be more spiritual impact during the week. Please only recruit and
take adult sponsors who encourage your students toward the goals of camp.
By attending Super Summer, your church acknowledges that it is responsible for the
selection and supervision of your adult sponsors and further warrants that it has exercised
due diligence in the selection of these adult sponsors.
WHO IS CONSIDERED A SPONSOR?
Sponsors must be individuals at least 18 years of age and one year removed from high
school.
CHURCHES MUST PROVIDE:
• At least one adult sponsor.
• One male and one female adult sponsor is strongly recommended.
• A ratio of one adult sponsor to every ten students is also strongly
recommended.
SPONSOR EXPECTATIONS
Adult sponsors attending Super Summer Missouri should adhere to these expectations:
• Set the moral and spiritual example for the group.
• Model and enforce the camp code of conduct and dress code.
• Ensure the attendance of their students at ALL required sessions (Team Meetings, Morning
Show, Recreation, and Evening Worship).
• When possible during the week equip and encourage students to follow Christ in their daily
lives.
• Have all adults sponsors attend the first Engage session on Monday after dinner.PROPERLY SELECTING ADULT SPONSORS
All churches are required to run background checks on their sponsors,
however, background checks are only a small part of a thorough sponsor
selection process. Group leaders should consider the following questions when
selecting sponsors for youth camp.
• ARE THEY ASSOCIATED WITH YOUR CHURCH? It is often tempting to select
people you know well as sponsors, but who have little to no connection to
your church. You need to be aware it is better to select qualified leaders
from your congregation than to outsource this type of help. People who
are not associated with your church do not always act as responsibly with
the church in mind, as those who are significantly invested in your
congregation.
• HOW LONG HAS THIS PERSON BEEN A MEMBER OF YOUR CHURCH?
Have they recently joined your congregation? It would be
important for you to be able to observe their life and character
for at least a minimum of six-eight months before considering
using them as adults sponsors.
• HOW WELL DO YOU KNOW THEM? ARE THESE PEOPLE YOU HAVE
KNOWN FOR AT LEAST A YEAR? They may be new members to your
church, but you may have known them much longer and can
vouch for their character. Do others speak highly of them and is
their observable character above reproach?
• DO THEY ENJOY BEING AROUND STUDENTS? Do they currently work
with students in your ministry and have a good rapport with
students and other workers? Do they observe good boundaries in
their relationships with students? Do they seem too strict or too
permissive? Have they agreed to abide by the requirements set
forth by the church and camp leadership?CAMPER SAFETY ZERO TOLERANCE
POLICY
Super Summer Missouri is committed to a positive, uplifting, Christian environment. Super Summer
does not tolerate and expressly prohibits sexual harassment and sexual abuse. This policy applies
to everyone at Super Summer, including executive staff, team leaders, small group leaders,
sponsors, and campers of Super Summer. Suspected violations of this policy are to be reported
immediately to the Super Summer Director. Upon completion of a review by the Director,
suspected violators of this policy will be removed from the college campus where Super Summer
is being held. Super Summer staff who are suspected of violating this policy will be subject to
disciplinary action, up to and including termination of employment and criminal prosecution may
ensue. Suspected abuse or neglect of a minor, whether on or off campus or whether perpetrated
by Super Summer personnel or others, will be reported to state authorities, as required by law. All
Super Summer staff have completed and cleared a background check, and have been
screened and vetted in accordance with MBC child safety and predator recognition training.
BACKGROUND CHECKS
Super Summer Missouri requires that each church perform background checks on all participants
18 years of age or older attending with their group. Super Summer Missouri honors background
checks for 18 months from the date of the check.
Background check providers must provide a national criminal
background check that includes...
• A check of the National Registry of Sex Offenders
• A county and/or state criminal court search.
Please use reputable, specialized firms who are able to provide the
specific types of checks that Super Summer requires!
DO NOT use the following types of agencies, companies, or
individuals to run your checks:
• Local, county, or state law enforcement agencies. These
organizations are obviously reputable, but their checks are
seldom, if ever, NATIONAL checks.
• Obscure providers found on a Google search.
• Friends or church members in or connected to law enforcement
that can get you a deal.RECOMMENDED REPUTABLE BACKGROUND CHECK PROVIDERS
The names of these organizations are provided as a means of convenience and easy
reference. These providers all charge a reasonable fee for their services; check with each
service provider for pricing. Churches are not required to use the recommended service
providers, but they are examples of the types of organizations your church needs to use
to run these checks.
Protect My Ministry (Plus Package) Praesidium Checks
www.protectmyministry.com http://www.praesidiuminc.com
(800) 319-5581 (800) 743-6354
Shield Checks Trak-1 Checks
www.shieldscreening.com https://www.trak-1.com
(800) 260-3738 (800) 600-8999
BACKGROUND CHECKS AND ON-SITE REGISTRATION
Background checks are run by service providers on behalf of the churches. The church
will be responsible for the information contained in the reports and will maintain the
privacy of those reports.
At Monday on-site registration, churches will produce the following documents and
registration officials will verify checks have been run on all necessary individuals.
• Completed Sponsor Background Check Compliance Form, along with a folder
containing a copy of the *report forms for all sponsors who have had background
checks run on them.
*The report form is the page of the background check that has the subject’s name and
any offenses listed.
Some churches will be randomly selected to have their checks further inspected to
determine if all sponsors are in compliance with camper safety requirements.FLAGGING BACKGROUND CHECKS
Each church is responsible to review the background checks that are run on their leaders
and sponsors and make determinations regarding each person’s suitability for service. In
order to help you as a church to make these determinations, we are providing you with
a list of RED FLAG and YELLOW FLAG offenses. These lists are thorough, but not exhaustive.
RED FLAG OFFENSES YELLOW FLAG OFFENSES (YFO)
If any of the following offenses are This is a list of felony and misdemeanor
reported on a potential sponsor’s offenses. Having one of these offenses
background check, you should not use appear on a person’s check will not
automatically disqualify them from being
that person as a sponsor at camp.
a sponsor. However, the church who
• Providing alcohol, tobacco, brings a person, whose check reveals a
drugs, pornography to a minor YFO, must also complete a YFO
• Voyeurism (peeping Tom) Acknowledgment Form for that person.
• Contributing to the delinquency The YFO Acknowledgment Form will serve
of a minor as a document stating that the church
• Criminal solicitation of a minor is aware of the Yellow Flag Offenses
found on the person’s background
• Public Indecency
check, is willing to take responsibility for
• Exhibitionism (flashing) the individual, and has determined the
• Assault person suitable to serve as a sponsor for
• Sexual Assault (or any crime that is the church at Falls Creek. The YFO
sexual in nature) Acknowledgment Form is online at
• Homicide www.mobaptist.org/supersummer.
• False Imprisonment
YFOs will include any of the following
• Kidnapping felony or misdemeanor offenses:
• Injury to a child/elderly
individual/ disabled individual • Driving under the influence
• Abandoning or endangering a child • Possession/Distribution of a
controlled substance
• Leaving a child in a vehicle
• Making a firearm accessible to a
• Matters related to interference child
with child custody • Theft, including identity theft
• Failure to stop or report the
aggravated sexual assault of a
childSPONSOR BACKGROUND CHECK FORM
The MBC has a policy that any individual over the age of 18 who is working with someone under
the age of 18 must be background checked. In order to comply with this policy every church
sending sponsors to Super Summer must verify that the church has a current background check
on file for those individuals.
I verify, that every indiviual over 18 we are sending as a sponsor to Super Summer Missouri has an
up-to-date background check on file at the church and to our knowledge nothing is contained
in their background report that would disqualify them from serving as a sponsor. We also
understand that are required to bring a copy of all background check reports with us to Super
Summer.
List the names of the sponsors you are sending to Super Summer:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
(List additional sponsors on the back of the form.)
By signing this document I am verifying that I have made no false or misleading statements. I also
acknowledge that any false or misleading statements regarding the background checks of any
individual over 18 from our church is subject to potential legal liability.
____________________________________________________________________________________________
Signed Name Date
____________________________________________________________________________________________
Printed Name
Please bring this form with you to camp. This form must filled out and signed, and you must have
a file with background check reports for all sponsors in order for your group to complete on-site
registration.STUDENT & ADULT REGISTRATION FORM
Type or print legibly in ink. Make sure all signatures are on form.
Name _____________________________________________Gender at Birth _________Age ____________
Address ____________________________________________________________________________________
City __________________________________________ State ____________ Zip Code __________________
Church:__________________________________________ City/State:________________________________
SESSION YOU WISH TO ATTEND:
____________ Session 1: June 13-16, 2021 – HLGU, Hannibal, MO
____________ Session 2: June 16-19, 2021 – HLGU, Hannibal, MO
____________ Session 3: June 20-23, 2021 – SBU, Bolivar, MO
____________ Session 4: June 23-26, 2021 – SBU, Bolivar, MO
T-SHIRT SIZE (Circle correct size below; t-shirt is included in registration cost.)
S M L XL XXL 3XL Other ___________________
I have read, understand, and agree to abide by the Super Summer Rules. I also understand that only
students who are able to attend the whole week of camp will be allowed to participate, and no late
arrivals or early departures are allowed.
The Missouri Baptist Convention will be videotaping and photographing at this event for possible inclusion
in future materials such as web and DVD formats for advertisement, newsletters, and other promotional
platforms.
By your signature of agreement to the terms and conditions, you are giving Missouri Baptist Convention
your consent to videotape, record, and cablecast you/your child’s picture, likeness, voice and statements.
If this poses a threat to compliance with any Missouri state laws that might apply to the participant, please
call our office at (573) 636.0400, ext. 365.
_____________________________________________________________________________________
Participant Signature Date
_____________________________________________________________________________________
Parent/Guardian Signature (if Participant is under 18) DateMEDICAL RELEASE FORM
Type or print legibly in ink. Make sure all information requested is given.
Name _______________________________________ Gender at Birth ________ DOB ________/________/_________
Age _____________ Phone (________) _______________________________
Address _______________________________________ City _________________________ State _______ Zip Code _____________
Church ___________________________________________________ City/State ____________________________________________
In event of emergency notify:
Name Home Number Work Number Cell Phone Number
1.______________________________ (______) _____________ (______) _____________ (______) _____________
2.______________________________ (______) _____________ (______) _____________ (______) _____________
Allergies (reactions to foods, drugs, insects) ___________________________________________________________________
Do you have – or have had in the past – any medical conditions (such as asthma, heart trouble, TB, migraine
headaches, nervous disorder, stomach trouble, mono, diabetes, cancer, etc.) of which the MBC should be made
aware? (Circle One) Yes No
Please list and explain ___________________________________________________________________________________________
_________________________________________________________________________________________________________________
Medications taking (and reason) _________________________________________________________________________________
_________________________________________________________________________________________________________________
Date of last tetanus shot ________/___________ Are you able to take Tylenol or other aspirin medications? _____________
(Month) (Year)
The person described on this registration form has my permission to be in all Super Summer activities at the place named
herein and on the dates named herein, except as noted by me. If a medical emergency should arise while my child
or ward is at Super Summer or in transit to Super Summer and I cannot be reached, I consent and give my permission
to the trip director or representative of Super Summer to select a physician and/or hospital for my child’s or ward’s
care. I also give the physician and/or hospital, as selected by the trip director or representative of Super Summer, my
permission to hospitalize, treat, give x-rays, tests and to order injections, anesthesia, or surgery for my child who is named
herein, which may in their sole discretion be necessary and proper under the circumstances. I do release, acquit,
discharge and covenant to hold harmless the (Church Name) ___________________________of (City/State)
___________________________, the Missouri Baptist Convention, its representatives, the trip director or Super Summer staff,
of any and all actions, damages, or liabilities arising out of the treatment of any sickness, or accident incurred by my
said child or ward to disclose any information there acquired, if requested. I understand that in the event of a medical
emergency requiring medical care, as I have authorized below, all costs for such emergency care ARE MY
RESPONSIBILITY and I agree to make payment of all such medical costs. I understand that I will be notified of medical
care, and that I must notify my insurance carrier.
Is this participant covered by Health Insurance? (Circle One): Yes No
If “Yes”, please attach a copy of his/her insurance card.
_____________________________________________________________________________________
Participant Signature Date
_____________________________________________________________________________________
Parent/Guardian Signature (if Participant is under 18) DateWaiver and Release of Liability and Conduct Policy
Disclaimer: Hannibal-LaGrange University is not responsible for any injury (or loss of property) to any person suffered
while participating in an activity or event at or while participating in voluntary mission or relief efforts on behalf of
Hannibal-LaGrange University for any reason whatsoever, including ordinary negligence on the part of Hannibal-
LaGrange University their agents, instructors, sponsors or employees.
In consideration of my participation in certain activities at or on behalf of Hannibal-LaGrange University, I hereby release
and covenant not to sue Hannibal-LaGrange University, Hannibal-LaGrange University Board of Trustees, and any of
their employees, instructors, or agents, from any and all present and future claims resulting from ordinary negligence on
the part of Hannibal-LaGrange University or others listed for property damage, personal injury, or wrongful death, arising
as a result of my engaging in events or activities or any activities incidental thereto, wherever, whenever, or however the
same may occur. I hereby voluntarily waive any and all claims resulting from ordinary negligence, both present and future,
that may be made by me, my family, estate, heirs, or assigns.
Further, I am aware that some activities are vigorous involving severe cardiovascular stress. I understand that these
activities involve certain risks, including, but not limited to, death, serious neck and spinal injuries resulting in complete
or partial paralysis, brain damage, and serious injury to virtually all bones, joints, muscles, and internal organs. I am
voluntarily participating in these activities with knowledge of the danger involved and hereby agree to accept any and all
inherent risks of property damage, personal injury, or death.
I further agree to indemnify and hold harmless Hannibal-LaGrange University, Hannibal-LaGrange University Board of
Trustees, and any of their employees, instructors, sponsors or agents for any and all claims arising as a result of my
engaging in these activities or any activities incidental thereto, wherever, whenever, or however the same may occur.
I understand that this waiver is intended to be as broad and inclusive as permitted by the laws of Missouri and agree that
if any portion is held invalid, the remainder of the waiver will continue in full legal force and effect. I further agree that
the venue for any legal proceedings shall be in the state of Missouri.
I affirm that I am of legal age and am freely signing this agreement or am a minor and my parent or legal guardian has
executed this document. I have read this form and fully understand that by signing this form, I am giving up legal rights
and/or remedies which may be available to me for the ordinary negligence of Hannibal-LaGrange University, Hannibal-
LaGrange University Board of Trustees, and any of their employees, instructors, or agents.
There is no use of alcohol, tobacco, or illegal drugs on campus.
There is to be no foul, abusive language, or behavior.
There is to be no gambling of any kind.
There are to be no firearms, fireworks, knives, or weapons of any kind on campus.
I understand and agree to abide by the policies of Hannibal-LaGrange University.
________________________________________________________________________________________________
PRINT (Name of Participant) SIGNATURE
________________________________________________________________________________________________
Signature of Parent if participant is under 18 Date
________________________________________________________________________________________________
Name of Group/Event
June 2018HLGU CHURCH ROSTER/ROOMMATE PREFERENCE FORM – FEMALES CHURCH________________________________________CITY/STATE__________________________ Use this sheet to indicate each participant’s roommate preference. Two people will be placed in each room – please plan accordingly. We will do our best to put your students together and adults together as they are listed on this sheet. Please note there is a separate form for male and female participants. All Super Summer participants from your group must be listed on the Church Roster Form – including all adults/leaders. Name (Female Students/Adults) Age Team Name/Color 1._____________________________ ______ ___________________ 2._____________________________ ______ ___________________ 1._____________________________ ______ ___________________ 2._____________________________ ______ ___________________ 1._____________________________ ______ ___________________ 2._____________________________ ______ ___________________ 1._____________________________ ______ ___________________ 2._____________________________ ______ ___________________ 1._____________________________ ______ ___________________ 2._____________________________ ______ ___________________ 1._____________________________ ______ ___________________ 2._____________________________ ______ ___________________
HLGU CHURCH ROSTER/ROOMMATE PREFERENCE FORM – MALES CHURCH________________________________________CITY/STATE__________________________ Use this sheet to indicate each participant’s roommate preference. Two people will be placed in each room – please plan accordingly. We will do our best to put your students together and adults together as they are listed on this sheet. Please note there is a separate form for male and female participants. All Super Summer participants from your group must be listed on the Church Roster Form – including all adults/leaders. Name (Male Students/Adults) Age Team Name/Color 1._____________________________ ______ ___________________ 2._____________________________ ______ ___________________ 1._____________________________ ______ ___________________ 2._____________________________ ______ ___________________ 1._____________________________ ______ ___________________ 2._____________________________ ______ ___________________ 1._____________________________ ______ ___________________ 2._____________________________ ______ ___________________ 1._____________________________ ______ ___________________ 2._____________________________ ______ ___________________ 1._____________________________ ______ ___________________ 2._____________________________ ______ ___________________
SBU CHURCH ROSTER/ROOMMATE PREFERENCE FORM – FEMALES CHURCH________________________________________CITY/STATE__________________________ Use this sheet to indicate each participant’s roommate preference. Two people will be placed in each room – please plan accordingly. We will do our best to put your students together and adults together as they are listed on this sheet. Please note there is a separate form for male and female participants. All Super Summer participants from your group must be listed on the Church Roster Form – including all adults/leaders. Name (Female Students/Adults) Age Team Name/Color 1._____________________________ ______ ___________________ 2._____________________________ ______ ___________________ 3._____________________________ ______ ___________________ 1._____________________________ ______ ___________________ 2._____________________________ ______ ___________________ 3._____________________________ ______ ___________________ 1._____________________________ ______ ___________________ 2._____________________________ ______ ___________________ 3._____________________________ ______ ___________________ 1._____________________________ ______ ___________________ 2._____________________________ ______ ___________________ 3._____________________________ ______ ___________________ 1._____________________________ ______ ___________________ 2._____________________________ ______ ___________________ 3._____________________________ ______ ___________________
SBU CHURCH ROSTER/ROOMMATE PREFERENCE FORM – MALES CHURCH________________________________________CITY/STATE__________________________ Use this sheet to indicate each participant’s roommate preference. Two people will be placed in each room – please plan accordingly. We will do our best to put your students together and adults together as they are listed on this sheet. Please note there is a separate form for male and female participants. All Super Summer participants from your group must be listed on the Church Roster Form – including all adults/leaders. Name (Male Students/Adults) Age Team Name/Color 1._____________________________ ______ ___________________ 2._____________________________ ______ ___________________ 3._____________________________ ______ ___________________ 1._____________________________ ______ ___________________ 2._____________________________ ______ ___________________ 3._____________________________ ______ ___________________ 1._____________________________ ______ ___________________ 2._____________________________ ______ ___________________ 3._____________________________ ______ ___________________ 1._____________________________ ______ ___________________ 2._____________________________ ______ ___________________ 3._____________________________ ______ ___________________ 1._____________________________ ______ ___________________ 2._____________________________ ______ ___________________ 3._____________________________ ______ ___________________
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