Summer 2020

Youth Camp Information

Corps Edition 02.19.20

Please keep this packet for your reference when sending kids to camp.

Dear Parent/Guardian of a Potential Hidden Falls Camper,

We are so excited that you are interested in sending your child to camp with us this summer! Whether they have been before or this is their first year – they are in for a great time!

Enclosed is some information about our camps for 2020, the Summer Tour. If you want to send your child to camp, please obtain registration forms from your local Salvation Army corps community center or online at www.hiddenfallscamp.org. Once you complete those forms, you can return them to your local Salvation Army church or representative. They will look over your application, and gather any additional information needed. They will also let you know if they are able to assist with transportation to get your child to camp and if any scholarships are available for your family.

The application has several parts, so please make sure you complete them all: 1. Camper Application 2. Camper Health & Medical History 3. Policies & Agreement 4. Participant Assumption of Risk and Waiver Agreement 5. Photo Release 6. Summer Food Service Program Form *MUST FILL OUT ALL PORTIONS* 7. Scholarship Application (optional)

The camp dates, descriptions, and the eligibility guidelines are on the next two pages. Please remember to indicate, on the first page of the application, which camps your child will actually be attending. Return your applications to your local Salvation Army as soon as possible. Registration for each camp will close when it is full or at two weeks prior to the camp’s first day.

Please also read through the enclosed camp information packet to make sure your child is ready for camp.

In Christ, Captains Anthony & Brianne Bowers Dan Bell Indiana Divisional Youth & Candidates Secretaries Hidden Falls Camp Director

HFC Summer Tour 2020

Camp Name: Outdoor Experience/Teen Camp Dates: June 8-12 (Mon-Fri)

Age requirement: Must be 12 by 7/9/20 and no older than 17

Description: This camp gives teens a taste of a camping experience; they will spend one night outdoors in a tent, with the rest of the time in the cabins. Besides some basic outdoor education, camp activities will be similar to Teen Camp. Camp Name: Extreme Camp/Pre-Jamboree Dates: June 8-12 (Mon-Fri)

Age requirement: Must be 12 by 7/9/20 and no older than 17

Description: This camp is for experienced outdoor campers that want a little more than a taste of the outdoors. In addition to sleeping outdoors in tents, activities will include longer hikes, backpacking, and an off-camp field trip. This camp is required for campers who are going to attend the Jamboree.

Camp Name: Kids Camp Dates: June 15-19 (Mon-Fri)

Age requirement: Must be 7 by 7/31/20 and no older than 12

Description: Campers will experience a variety of activities/classes that have to do with several aspects of camp and being outdoors. This camp will also have an evangelic focus while experiencing the outdoors as God’s creation.

Camp Name: Music Week Dates: June 20-27 (Sat-Sat)

Age requirement: Must be 9 by 7/31/20 and no older than 17

Description: This is a working camp for music instruction. Those who do not currently attend programs at their local Salvation Army are welcome to attend if they have a music teacher recommendation.

Specific Camp Options: Band Camp (Must bring instrument. Brass, Woodwind or Percussion only)

Choir Camp Guitar Camp (Bring guitar if you have one; we have some available) Camp Name: Junior Music Camp Dates: June 23-27 (Tues-Sat)

Age requirement: Must be age 7 by 12/31/20, and no older than age 8.

Description: This is an introduction to music where youth will be participating in choir, as well as getting a taste of other areas of music. Campers MUST be involved in local Salvation Army programs to attend this camp.

Continued on next page

HFC Summer Tour 2020

Camp Name: Jamboree Dates: July 15-19 (Mon-Fri)

Age requirement: Must be 12 by 7/9/20 and no older than 17

Description: The Jamboree is a Territorial event that is held every 4 years. Hidden Falls Camp is the host of this year’s Jamboree. Delegates MUST be involved in Salvation Army programming. Registration is ONLY available through www.sajamboree.org and not in this packet.

Camp Name: Sports Week Dates: July 16-20 (Thurs-Mon)

Age requirement: Must be 9 by 7/31/20 and no older than 17

Description: Campers will choose ONE sport to participate in throughout the week. Campers are welcome to register for a sport whether they are a beginner or experienced. Campers who are beginners will leave camp knowing the basic skills and rules of their sport. Campers who are experienced will work on refining their skills.

Specific Camp Options: Soccer Camp Basketball Camp Softball Camp

Cheer Camp Tae Kwon Do Camp Archery Camp Camp Name: STEM + Art Camp Dates: July 21-24 (Tues-Fri)

Age requirement: Must be age 9 by 7/31/20, and no older than 14.

Description: Campers will choose ONE class to participate in throughout the week. All classes relate to an area of STEM, and several have Art intertwined. Please know that class sizes are limited! Register ASAP to get the class you want.

Specific Camp Options: Engineering Robotics Environmental Science Computer Science Chemistry Photography Woodworking Culinary Arts

Special Camp Considerations

Outdoor Experience Camp

• Your camper will be tent camping for one night which includes: o Sleeping in tents in the woods o Using a port-a-potty

• Your camper will be participating in active outdoor activities including hiking and range sports.

• Please be sure to pack (along with normal packing list): o Two pairs of CLOSED-TOED SHOES (in case one pair gets wet/muddy) o Bug Spray o Flashlight o Water bottle

Extreme Camp/Pre-Jamboree

• This is a very physically active camp.

• Your camper will be primitive camping which includes: o Sleeping in tents in the woods o Using a port-a-potty o Cooking meals over a fire

• Your camper will be participating in many active outdoor activities including: o A five mile hike around camp o A kayak or canoe trip off-camp o Range Sports

• Please be sure to pack (along with normal packing list): o Two pairs of CLOSED-TOED SHOES o Bug Spray o Flashlight o Water bottle

Music Camp

• This is a working camp.

• Your camper will be expected to participate in a choir, guitar, or band track.

• Traditional “camp” activities will only be offered during choice time in the afternoons

• Campers in band track need to bring their instrument

• Campers in guitar track should bring an acoustic guitar if they have one. There will be some guitars available to those who do not own one.

Sports Week

• This is a very physically active camp.

• Your camper will be expected to participate in the sport he/she chose all week long.

• Please be sure to pack closed toed shoes as your camper will be involved in various sporting activities.

• We will have all the necessary sports equipment, however if your camper owns equipment that they prefer to use (ex. A mitt for softball, particular shoes, uniform for martial arts, etc), they are allowed to bring those items. Please make sure that items are marked with camper’s name!

ELECTRONICS POLICY AT HIDDEN FALLS SUMMER CAMPS

Help our campers “unplug” – please leave all electronics at home! Our Electronics Policy is designed to: • Encourage your children to spend more time in the outdoors • Promote socialization between campers • Remove the divide between “the haves and the have-nots” in each cabin • Reduce the stress associated with the damage to and theft of electronics • Give your children a much needed break from the world of technology • Ensure that your children are not exposed to age-inappropriate material • Ensure that your children cannot post their camp photos on the internet • Ensure that your children are not focusing on situations revolving around their friends at home • Prevent your children from hearing about situations and incidents concerning home and family before

their parents have a chance to communicate with them Cell Phones It has been our policy that campers are NOT PERMITTED to have a cell phone at camp. When you allow your child to break the rules and take a cell phone to camp, please consider that you’re teaching your child that the rules do not apply to your family. We believe that being at camp is an opportunity for your child to experience a world beyond home and a chance for you and your child to practice “letting go.” “Letting go” allows children to develop autonomy, independence, and a stronger sense of self. It allows them to make new friends, take responsibility for themselves and their cabin-mates, problem solve, and mature a bit. These things cannot be achieved when parents are only a call or text away. Although we have asked campers to not bring cell phones for years, a number of families often choose to ignore this policy. Consequences include conflicts within the cabin and allowing campers to focus on their friends at home rather than their friends at camp. Cell phones enable campers to call parents when they need advice instead of turning to their peers or counselors, and prevent campers from problem solving. We feel cell phone use at camp is counter to the values we teach and uphold at Hidden Falls Camp and interferes with an important peer aspect of the overnight camp experience. We have been asked if they can use their phones to tell the time or as an alarm. The problem with this is we have found that having the cell phone holds too much temptation to check texts, emails, social media, etc. Campers are always allowed to ask camp staff what the time is, and Cabin counselors are responsible for waking up their campers. If a camper wants to wake up at a certain time, all he/she needs to do is ask the counselor. If campers do travel to camp with cell phones, they will be asked to turn them in during registration. The cell phones will be kept in a locked box/safe, and will be returned upon camper dismissal. Digital Cameras Campers are allowed to bring inexpensive (point and shoot type) cameras. However, please discuss proper handling of the camera and how pictures should be taken of other campers ONLY with their permission. If we find out that your child is taking pictures of people without permission, we will confiscate the camera, delete the picture in question, and return the camera to your child upon dismissal. Leave expensive cameras at home. Hidden Falls Camp and the Salvation Army is not responsible for anything that is lost, broken or stolen.

Do not bring to camp:

• iPads, tablets, kindles, etc.

• Laptops or computers

• iPods or mp3 players

• Gaming devices, any kind of hand-held electronic games If found, we will confiscate any of the above listed electronic devices and return them upon dismissal. One last word on Electronics We recommend that your child powers down, unplugs, and takes what we’re certain is a well-needed break from the world of electronics. Campers are welcome to bring other “interactive” things, like playing cards, checkers/chess, word games, etc. Please be respectful of the usage and content limitations we have in place. We are confident that “unplugging” will result in more time playing together, enhanced interaction between cabin-mates and more overall fun. When campers bring electronic devices to camp, not only does it remove them from the camp experience, but devices can sometimes get lost, broken, or stolen. Hidden Falls Camp and The Salvation Army cannot take responsibility for their loss or damage, nor does out insurance policy cover their replacement. If you have any further questions, please contact the Youth Department by emailing uscindyouth@usc.salvationarmy.org.

Snack Shop Information Included with your payment for your child to go to camp, he/she is given a wristband that is worth $5 to be spent at our camp snack shop. Campers typically have two times a day they may visit the snack shop: in the afternoon, and after the evening program. Some of the items offered at the snack shop include: chips, candy, ice cream, pop, juice, popcorn, nachos, soft pretzels, snow cones, and more. The snack shop also sells Hidden Falls Camp items such as water bottles, sunglasses, clothing, etc. (based on availability). If you wish for your child to have more than $5 to spend at the snack shop, you will need to bring cash when you drop off your child at camp (or give to the Salvation Army leader who is transporting your child). Please DO NOT send your child with cash in their suitcase/backpack. Cash MUST be turned in at registration. Wristbands are the only way that campers are allowed to pay for items at the snack shop. If your child does come to camp with additional snack shop cash, when they use up their first wristband, they need to tell the snack shop staff that they need their next wristband. Once a camper is issued a wristband, refunds are NOT give for the balance remaining on the band. However, any amount not received via wristband will be refunded. For this reason, additional wristbands are not issued on the last night of camp. We encourage campers to use up their balance on the last night of camp. However, they can save any unused wristband and use it at the next camp. If your child has a wristband from 2019, they may use it this summer. If your child attended camp in 2019 and purchased one of our reusable cups, please remember that they can and should bring those cups back to camp again this summer to receive 50 cent refills, instead of paying for a new cup again.

Head Lice Policy

All campers’ heads will be checked for head lice upon arriving at Hidden Falls Camp. Please make sure to check several days before the camp starts and take care of any issues found. If lice or nits are found, the camper will be sent home and may NOT be allowed to return until the next camp for which they are eligible. Please take the appropriate measures to ensure this unfortunate outcome won’t affect your camp experience. This policy is non-negotiable and is for the protection of the camper. A simple exchange of hats, clothing brushes, combs, pillows and other personal articles can result in transmission of head lice from one child to another. Lice can be easily and effectively treated. This must be done prior to attending any camp. Contact your doctor or your Health Division or purchase a non-prescription head lice preparation from a drugstore and follow directions carefully.

1. Inspect Carefully examine hair and scalps of all family members for lice and their eggs. Lice are small grayish-tan, wingless insects. Lice lay eggs called nits. Detect Nits Nits are firmly attached to the hair shafts, close to the scalp. Nits are much easier to see and detect than lice. They are small white specks, which are usually found at the nape of the neck and behind the ears.

2. Treat Use a Pediculicide Once head lice and/or nits are found, your doctor may prescribe a medicine called a pediculicide. You may also purchase a non-prescription head lice preparation from a drugstore. Be sure to follow the directions exactly. Use a Nit Comb After hair has dried thoroughly, the nits may be removed with a special nit comb.

3. Clean Up Environment Wash Make sure persons with head lice do not share articles (combs, brushes, towels, hats, scarves, pillows, etc.) that have come in contact with their head, neck or shoulders. Use hot water to wash lice-exposed clothes, towels and bed linens. Soak combs and brushes in hot water for 10 minutes. Dry-clean hats and clothing that cannot be washed (or seal in a plastic bag for at least two weeks.) Vacuum carpets, upholstery, pillows and mattresses which may have been exposed to persons with head lice.

NOTE: If one child’s infestation is overlooked, the stage is set for transmission to the rest of the camp. Therefore, if there is any evidence of live lice when a camper arrives, they will have to return home for treatment. They cannot be treated at camp. Anyone sent home for treatment may return to later camps if they are found to be symptom-free.

___________________________________

Camper Name

__________________________________

Corps or Unit

Summer Camp 2020 Registration

Please place a check mark on the camp(s) you plan to attend and return to your local Salvation Army Corps or unit.

❑ Outdoor Experience Camp/Teen Camp

June 8-12 (Mon-Fri)

For youth ages 12-17. This camp is to get a taste of the outdoors,

with some elements of Teen Camp. 3 nights in a cabin, 1 night

outside in a tent.

❑ Extreme Camp/Pre-Jamboree

June 8-12 (Mon-Fri)

For youth ages 12-17. This camp is for experienced outdoor campers

that want a more rustic experience. Attendance is required for

Salvation Army youth who are registered for the Jamboree.

❑ Kids Camp

June 15-19 (Mon-Fri)

For youth ages 7-12.

Music Week

June 20-27 (Sat-Sat)

For youth ages 9-17 (Youth who do not attend programs at the

Salvation Army may attend with a music teacher recommendation).

This is a working camp. Please choose ONE of the following camps

for the week.

❑ Band Camp (Brass, Woodwind, or Percussion only)

❑ Choir Camp

❑ Guitar Camp

❑ Junior Music Camp

June 23-27 (Tues-Sat)

For youth ages 6 ½ -8 who attend programs at their local Salvation

Army.

Sports Week

July 16-20 (Thurs-Mon)

For youth ages 9-17. Please choose ONE camp for the week.

❑ Soccer Camp

❑ Cheer Camp

❑ Archery Camp

❑ Basketball Camp

❑ Martial Arts Camp

❑ Softball Camp

STEM + Art Week

July 21-24 (Tues-Fri)

For youth ages 9-14. Please choose ONE camp for the week.

❑ Engineering

❑ Robotics

❑ Environmental Science

❑ Computer Science

❑ Chemistry

❑ Photography

❑ Woodworking

❑ Culinary Arts

1. CAMPER INFORMATION (Please Print)

Last Name: First Name: Sex: (circle) M F

Address: Birthdate: Age:

City: Grade Entering in Fall 2020:

State: Zip: Corps/Church:

Camp T-Shirt Size: (please circle) Youth: S M L Adult: S M L XL 2XL 3XL 4XL

2. PARENT/GUARDIAN INFORMATION (Please Print)

Parent 1 Name: Parent 2 Name:

Cell Phone: Cell Phone:

Other Phone: Other Phone:

Email address: Email address:

3. EMERGENCY INFORMATION (Please Print) If parent/guardian cannot be reached

Name: Name:

Relationship: Relationship:

Cell Phone: Cell Phone:

Other Phone: Other Phone:

4. HOUSEHOLD INFORMATION (Please Print) Does camper have siblings or other family members (in the same household) who will

also attend Hidden Falls Camp this year?

Name: Name: Name:

Relationship: Relationship: Relationship:

Name: Name: Name:

Relationship: Relationship: Relationship:

5. OPTIONAL DEMOGRAPHICAL INFORMATION Corps Assessments and various grants allow us to keep camper cost low at Hidden

Falls Camp. Many grants require demographical information of our campers. While this section is optional, it is extremely helpful in reporting to funders. None of this information will determine your child’s eligibility to attend camp.

Race: ____African American ____Asian/Pacific Islander ____Caucasian ____Native American/Alaska Native ____More than one race ____Other

Ethnicity: ____ Hispanic ____ Non-Hispanic

Type of Household: ____Two Parents ____Single Parent ____Grandparent ____Foster ____Other

6. Additional Camper Information (Please Print) Is there any other information about your child that would be helpful to make

their camping experience successful?

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Camper Heath and Medical History

1. Camper Information (Please Print)

Name: Birthdate: Age: Sex: M F

Parent Name & Cell phone: ___________________________ Emergency Contact Name & Cell phone: ___________________________________

2. Medication Information (Please Print) Any camper who needs medication dispensed at camp MUST have this section completed. ALL

MEDICATIONS MUST BE IN ORIGINAL CONTAINER WITH PRESCRIPTION LABEL AFFIXED. Name of Medication Time/Dosage Given Reason for Medication

1

2

3

4

5

3. Current Medical Information (Please Print)

Allergies:

Dietary Restrictions:

Activities to be limited:

Name of Family Physician: Phone:

Do you carry Medical Insurance? Yes No If Yes, Name of Insured:

Carrier: Policy or Group Number:

Medical Assistance #: Additional Info:

4. General Health History Has/does the camper:

____ Ever been hospitalized? ____ Ever had surgery? ____ Have a recurrent/chronic illness? ____ Had a recent infectious disease? ____ Had a recent injury? ____ Had asthma/wheezing/shortness of breath? ____ Ever had back/joint problems?

____ Have diabetes? ____ Had seizures? ____ Had headaches/migraines? ____ Wear glasses or contacts? ____ Had fainting or dizziness? ____ Have any skin problems? ____ Have a history of bedwetting?

____ Passed out/had chest pain during exercise? ____ Had mononucleosis “mono” in the past year? ____ If female, had problems with periods? ____ Have problems with falling asleep or sleepwalking? ____ Have problems with diarrhea or constipation? ____ Traveled outside the US in the past 9 months?

Explanation of checked answers above: _________________________________________________________________________ __________________________________________________________________________________________________________

5. Mental, Emotional, and Social Health Has the camper:

____ Ever been treated for ADD or ADHD? ____ Ever been treated for emotional or behavioral difficulties or an eating disorder?

____ During the past 12 months, seen a professional to address mental/emotional health concerns? ____ Had a significant life event that continues to affect the camper’s life?

Explanation of checked answers above: _________________________________________________________________________ __________________________________________________________________________________________________________

5. Over the Counter Medicines/Treatment. Check those which CAN BE applied and/or administered to this camper while at HFC.

____Acetaminophen (Tylenol) ____Ibuprofen (Advil, Motrin) ____Antihistamine (Benadryl) ____Decongestant (Sudafed PE)

____Cough Suppressant (Robitussin) ____Bismuth subsalicylate (PeptoBismol) ____Loperamide (Imodium) ____Antacid (Tums, Rolaids)

____Insect Repellent ____Sunscreen ____Aloe ____Calamine Lotion

____Hydrocortisone Cream ____Antibiotic Ointment ____Cough Drops ____Sore throat spray

IMPORTANT This section MUST be completed for attendance at camp. By my signature below, I am stating that this health history is correct to my knowledge, and the person herein described has permission to participate in all camp activities unless stated in writing by physician. I hereby give permission to the medical personnel selected by a representative of The Salvation Army to order X-rays, routine tests, treatment; to release records necessary for insurance purposes; and to provide or arrange necessary related transportation for me/or my child. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by a Salvation Army representative to secure and administer treatment including hospitalization, for the person named above. This completed form may be photocopied for trips out of camp.

Signature of parent/guardian or adult camper: ___________________________________________________________________ Witness: __________________________________________________________________ Date: __________________________

Policies & Agreement

Parent Contact

Camp Leadership will call the parent/guardian, identified on this form; any time health care outside of camp is necessary for your child. In an emergency,

should the parent/guardian not be available by phone, we will call the alternate contacts. Emergency care will not be withheld in the event the parent/guardian or

alternate contact is not available by phone. Campers will not have regular access to a phone to contact their parents, but messages can be left at the office to be

given to campers. Parents may also leave messages for campers by emailing uscindyouth@usc.salvationarmy.org.

Head Lice

Your child will be checked for head lice upon arrival at camp. If lice or nits are found, your child will be sent home. Your child will not be able to return to

the current camp. Please take the appropriate measures to ensure this unfortunate outcome won’t affect your child’s camp experience. This policy is non-negotiable

and is for the protection of all campers. Please see the Head Lice Policy in the attached camp information packet for treatment procedures to ensure that your child

can attend future camps.

Dress Code

The camper is expected to abide by the dress code as outlined in the attached camp information packet. If camp leadership indicates that the camper’s

clothing breaks the dress code, the camper must change his/her clothing before being allowed to resume camp activities. If the camper refuses to change, this may

result in parent contact and possible dismissal from camp.

Cell Phone Policy

Campers will NOT be allowed to have their cell phones while on camp property. If campers have a cell phone during registration, or a cell phone is found

throughout the week, it will be confiscated, locked in the camp safe, and then returned upon dismissal.

Medications

All medications (including over the counter or nonprescription medication) MUST be turned in to the Camp Health Officer. They must be in the original

container (or accompanied by a doctor’s note) that identifies the prescribing physician, the name of the medication, dosage, and the frequency of administration.

Over the counter medication will only be administered on a regular basis if accompanied by a note from a physician indicating the above information. Bring enough

medication to last the duration of the camp. Please Note: If your child needs medication when attending school, then that medication is also needed at camp.

Parent Agreement (MUST BE COMPLETED FOR ATTENDANCE)

I wish to enroll ____________________________________ in the above camp sessions. In signing this application I understand that my child will be expected to abide by the rules of the camp and the guidance of his/her leaders. I will help my child understand the importance of getting along with other campers and obeying camp leaders. I agree that my child shall participate in the entire camp program set up by The Salvation Army which includes religious services. I understand that if my child does not adhere to the camp policies and/or has severe misconduct, he/she may be sent home and that is my responsibility to provide transportation home from Hidden Falls Camp. By signing below, I also understand and give permission for my child to ride in a Salvation Army vehicle for transportation to and from Hidden Falls Camp, while on camp for special circumstances including field trips. I hereby give my permission for my child to participate in off-camp activities should these be included in the schedule.

_____________________________________________________________ _________________________ Parent Signature Date

Camper Code of Conduct (MUST BE COMPLETED FOR ATTENDANCE)

I ____________________________________________ agree to conduct myself in a manner that will be a credit to me, to Hidden Falls Camp, to The Salvation Army, to all involved in the summer camp session , and to my church/corps community. I will :

• Dress appropriately and wear whatever clothing and/or equipment required for activities.

• Show respect for the rights, privacy and property of others.

• Show respect for the property and facilities of Hidden Falls Camp and The Salvation Army

• Comply with the schedule for programs, activities, meal times and limitations of free time activities.

• Not possess or use any alcohol, tobacco, drugs, or profanity while at Hidden Falls Camp

• Not bring to camp flammable or explosive materials, poisons, weapons, pets, or cell phones.

• Take responsibility for my own personal property.

• Agree to abide by all local, state and federal laws and rules and regulations issued by HFC staff and The Salvation Army.

• Cooperate with and show respect to the camp staff, other participants, representatives of HFC, The Salvation Army and invited guests

• Follow guidelines for public displays of affection

• Attend and be reverent in all worship services at Hidden Falls Camp By signing, I promise to be a good camper at Hidden Falls Camp. I will obey the rules, policies and camper code of conduct. I will respect all other campers and leaders. I understand that if I break the rules or show disrespect for others, I may be sent home. I sign this on my honor

_______________________________________________________________ __________________________ Camper Signature Date

The Salvation Army Hidden Falls Camp

Challenge Course, Paintball, Archery, Rifles and Bikes

Participant Assumption of Risk and Waiver Agreement

_____________________________________________ _Salvation Army Summer Camps __________________ Print Participant Name Print Name of Group

_____________________________________________ _____________________________________________ Parent/Guardian Name if under 18 years of age Date

Instructions: Please read this form carefully. Each participant and his/her parent/guardian must sign at the bottom. Without all the appropriate

signatures, the individual will not be permitted to participate in the programs.

The challenge course program involves a variety of activities including warm-ups, games, group initiatives, low and high course elements, and

possibly other rigorous physical adventure activities. The paintball, archery, and riflery programs involve a variety of activities, including target

practice and team competitions. The bike program involves a variety of activities including both trail and pavement riding.

I understand that I will be participating in activities that involve periods of physical exertion, balancing, heights, lifting, pushing, pulling, climbing,

cycling, shooting, marking, and exposure to paintball pellets. I know most activities will be outdoors where I will need to watch for slippery and/or

uneven footing, limbs and branches, insects or animals, and possible exposure to extreme or inclement weather.

I understand that there is a risk of bodily and/or psychological injury, including a potential for permanent disability or death, resulting from any

participation in the programs and/or from equipment involved in my participation. I understand that the risks also include loss or damage to

personal property. I freely assume all such risks, both known and unknown, and assume full responsibility for my participation. I understand that I

will be thoroughly informed of the rules of participation, including all safety related rules, and agree to fully comply with them during my

participation.

I understand that all possible precautions are taken to insure that all programs and activities sponsored by The Salvation Army Hidden Falls Camp

and Conference Center are conducted by mature, qualified, and certified personnel in a safe and responsible manner.

I understand that my participation in challenge course, paintball, archery, bikes, and riflery programs offered by Hidden Falls Camp and Conference

Center is based on the Participation is Voluntary philosophy. At all times I will choose my level of participation in any activity. I agree to exercise

good personal judgement, to ask for help if concerned about my safety, and to be responsible for deciding if a proposed activity is appropriate for

me.

I have informed the camp on the appropriate medical form of any physical, mental, or medical condition that might affect my ability to participate

or affect other members in my group. I realize that failure to provide such information could result in serious harm to me, my child, or others. I also

state that I am not under the influence of any chemical substance, including alcohol.

I, for myself and on my behalf of my heirs, assigns, personal representatives and next of kin hereby release and hold harmless The Salvation Army,

an Illinois Corporation, its officers, employees, agents, and associates and The Salvation Army Hidden Falls Camp and Conference Center, its

employees, agents, and associates, harmless for accidents, injury, death, loss or damage to property that might occur during these programs.

By signing this waiver I indicate that I have read and understand all materials outlining the challenge course, paintball, archery, bikes and riflery

programs participation for myself, including this waiver and agree to abide by these terms. I am aware that this is a waiver and a release of liability,

and I sign it voluntarily.

If I am completing this form for my minor aged child, I give permission for him/her to participate in these activities.

__________________________________________________ ___________________________________________________

Signature of Participant Signature of Parent/Guardian under 18 years of age

__________________________________________________ ___________________________________________________

Address Phone Number

__________________________________________________

City, State, Zip

The Salvation Army

Photo Release Form

PURPOSE:

To obtain from photo and interview subjects the right to use their portraits and statement in Salvation Army

publications, promotions, and/or advertising. Those under the age of 18 must have a parent or legal guardian

to sign for them.

LEGAL:

I hereby irrevocably grant to The Salvation Army the absolute right and permission to copyright and/or publish

or use photographic portraits of me (or my child), or in which I (or my child) may be included in whole or in

part, or composite or distorted in character form, in conjunction with my (or my child’s) name or a fictitious

name, or reproductions thereof in color or otherwise, made through any media, including social, for art,

advertising or any other lawful purpose whatsoever. I also grant The Salvation Army the same right and

permission to use any statements or testimonials made by me (or my child).

Please fill out ONE of the boxes below.

I DO give permission.

Camper Name: Date:

Address: Phone:

City, State, Zip:

E-mail Address:

Parent/Guardian Name: (print)

Parent/Guardian Signature:

Witness Signature:

I do NOT give permission to The Salvation Army to use my (or my child’s) photograph or statements in any

publication. *PLEASE FILL OUT THIS SECTION IF CAMPER IS A FOSTER CHILD*

Camper Name: Date:

Parent/Guardian Name: (print)

Parent/Guardian Signature:

Summer Camp Scholarship Application

Camper Name: _____________________________________________________________________________

Salvation Army Corps/Unit: ___________________________________________________________________

List the Camp(s) your Child will be attending 1. 2.

3.

4. 5.

Parent/Guardian Name(s): ____________________________________________________________________

Phone Number: ______________________________ E-mail: _______________________________________

List ALL persons residing in your household (Total Number ______)

Total of ALL Household Monthly Income (Before Taxes): $______________

Signature: _________________________________________________ Date: __________________________

Please submit Scholarship Application with Camper(s) Application to your local Salvation Army corps or

representative. They will contact you about your scholarship eligibility and payment deadline.

Office Use Only

Date Received ____/_____/____ Date Applicant Contacted: ____/____/____

Qualify: ____Yes ____No Camper Fee (Per Camper/Session) _______ Payment Deadline _______

Summer Food Service Form Instructions

*Please complete this form even if you believe you are not eligible*

In order to keep costs down for campers during the summer, we apply for grant money from

the USDA Summer Food Service Program. For us to receive this money, we need the following

form filled out for every camper. We realize that many families have more than one child going

to camp, but it is important to have a separate sheet with the same information for each child.

Our representative requires us to have a form for each child.

STEP 1: List ALL household Members who are infants, children, and students up to and

including grade 12.

• Please make sure to list ALL children in the household, not just the camper.

• If more spaces are required for additional names, attach another sheet of paper.

STEP 2: Do any household members (including you) currently participate in one or more of the

following assistance programs: SNAP, TANF, or FDPIR?

• If no, go to step 3.

• If yes, you MUST provide your case number, otherwise please move to Step 3.

• If yes, and you have provided a case number, you may skip Step 3 and move onto Step 4.

STEP 3: Report Income for ALL Household Members

• You may skip this step IF you have provided a case number for Step 2.

• All income includes child income (if teen child earns income).

• Be sure to write total household members.

• Also, please be sure to include the LAST 4 DIGITS of your Social Security number.

STEP 4: Contact information and adult signature

OPTIONAL: On the second page, please indicate the child’s racial and ethnic identities.

Apply online at www.abcdefgh.edu2016­2017 Prototype Household Application for Free and Reduced Price Summer MealsComplete one application per household. Please use a pen (not a pencil).

 

 

 

    

 

 

 

Definition of Household Member: “Anyone who is living with you and shares income and expenses, even if not related.”

Children in Foster care and children who meet the definition of Homeless, Migrant or Runaway are eligible for free meals. Read How to Apply for Free and Reduced Price School Meals for more information.

 

 

Household Application for Free and Reduced Price Summer Meals

STEP 1 List ALL Household Members who are infants, children, and students up to and including grade 12 (if more spaces are required for additional names, attach another sheet of paper)

Definition of HouseholdMember: “Anyone who is living with you and shares income and expenses, even if not related.”

Children in Foster care and children who meet the definition of Homeless, Migrant or Runaway are eligible for free meals. Read How to Apply for Free and Reduced Price School Meals for more information.

Homeless,Student? Foster Migrant,Child’s First Name MI Child’s Last Name Grade

Yes No Child Runaway

Che

ck a

ll th

at a

pply

Do any Household Members (including you) currently participate in one or more of the following assistance programs: SNAP, TANF, or FDPIR? 

STEP 3

STEP 2

Not sure what income to include here?

Flip the page and carefully review the charts titled “Sources of Income” for more information.

The “Sources of Income for Children” chart will help you with the Child Income section.

The “Sources of Income for Adults” chart will help you with the All Adult Household Members section..

Last Four Digits of Social Security Number (SSN) ofTotal Household Members X X X

Pensions/Retirement/

Check if no SSN(Children and Adults) Primary Wage Earner or Other Adult Household Member

X X

Contact information and adult signatureSTEP 4

“I certify (promise) that all information on this application is true and that all income is reported.  I understand that this information is given in connection with the receipt of Federal funds, and that school officials may verify (check) the information. I am aware that if I purposely give false 

Report Income for ALL Household Members  (Skip this step if you answered ‘Yes’ to STEP 2)

Case Number:If NO  > Go to STEP 3. If  YES >  Write a case number here then go to STEP 4 (Do not complete STEP 3)

Write only one case number in this space.

How often? Child IncomeA.

Sometimes children in the household earn income. Please include the TOTAL income earned by all Household Members listed in STEP 1 here. $

Child income Weekly Bi-Weekly 2x Month Monthly

All Adult Household Members (including yourself)B.List all Household Members not listed in STEP 1 (including yourself) even if they do not receive income. For each Household Member listed, if they do receive income, report total gross income (before taxes) for each source in whole dollars (no cents) only. If they do not receive income from any source, write ‘0’. If you enter ‘0’ or leave any fields blank, you are certifying (promising) that there is no income to report.

How often? How often? How often?

Name of Adult Household Members (First and Last)

$

$

$

$

$

Earnings from Work Weekly Bi-Weekly 2x Month Monthly Public Assistance/ Child

$

Support/Alimony Weekly Bi-Weekly 2x Month Monthly

$

$ $

$ $

$ $

$ $

All Other Income Weekly Bi-Weekly 2x Month Monthly

information, my children may lose meal benefits, and I may be prosecuted under applicable State and Federal laws.”

Street Address (if available) Apt # City  State  Zip 

Printed name of adult completing the form Signature of adult completing the form

Daytime Phone and Email (optional)

Today’s date

                                                                            

                                                                            

                                                          

                                                                        

                                                                                             

             

          

              

                                  

        

                                                  

 

   

 

 

         

 

  

 

                           

Household Application for Free and Reduced Price Summer Meals

Source of Income for Childen

Sources of Child Income Example(s)

­ Earning from work ­ A child has a job where they earn a salary orwages

­ Social Security­ Disability Payments­ Survivor’s Benefits

­ A child is blind or disabled and receivesSocial Secrity benefits­A Parent is disabled, retired, or deceased, andtheir child receives social security benifits

­Income from person outside the household ­ A friend or extended family memberregularly gives a child spending money

­Income from any other source ­ A child receives income from a privatepension fund, annuity, or trust

Source of Income for AdultsEarnings from Work Public Assistance / Alimony /

Child Support Pensions / Retirement /

All Other Income

­ Salary, wages, cash bonuses­ Net income from self­employment (farm orbusiness)­ Strike benefits

If you are in the U.S. Military:

­ Basic pay and cash bonuses(do NOT include combat pay, FSSA or privatized housingallowances)­ Allowances for off­basehousing, food and clothing

­ Unemployment benefits­ Worker’s compensation­ Supplemental SecurityIncome (SSI)­ Cash assistance from Stateor local goverment­ Alimony payments­ Child support payments­ Veteran’s benefits

­ Social Securtity (includingrailroad retirement andblack lung benefits)­ Private Pensions ordisability­ Income from trusts aorestates­ Annuities­ Investment income­ Earned interest­ Rental income­ Regular cash paymentsfrom outside household

Sources of IncomeINSTRUCTIONS

Children's Racial and Ethnic IdentitiesOPTIONAL

We are required to ask for information about your children’s race and ethnicity. This information is important and helps to make sure we are fully serving our community. Responding to this section is optional and does not affect your children’s eligibility for free or reduced price meals.

Ethnicity (check one):  Hispanic or Latino  Not Hispanic or LatinoRace (check one or more): American Indian or Alaskan Native Asian            Black or African American     Native Hawaiian or Other Pacific Islander  White

The Richard B. Russell National School Lunch Act requires the information on this application. You do not haveto give the information, but if you do not, we cannot approve your child for free or reduced price meals. Youmust include the last four digits of the social security number of the adult household member who signs theapplication. The last four digits of the social security number is not required when you apply on behalf of afoster child or you list a Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for NeedyFamilies (TANF) Program or Food Distribution Program on Indian Reservations (FDPIR) case number or otherFDPIR identifier for your child or when you indicate that the adult household member signing the applicationdoes not have a social security number. We will use your information to determine if your child is eligible forfree or reduced price meals, and for administration and enforcement of the lunch and breakfast programs. WeMAY share your eligibility information with education, health, and nutrition programs to help them evaluate, fund, or determine benefits for their programs, auditors for program reviews, and law enforcement offi cials to help them look into violations of program rules.

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, sex, religious creed, disability,age, political beliefs, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA.

Persons with disabilities who require alternative means of communication for program information (e.g. Braille,large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where theyapplied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877­8339. Additionally, program information may be made available in languages other than English.

To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form,(AD­3027) found online at: http://www.ascr.usda.gov/complaint_filing_cust.html, and at any USDA offi ce, or writea letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632­9992.  Submit your completed form or letter to USDA by: 

mail:  U.S. Department of Agriculture

Office of the Assistant Secretary for Civil Rights

1400 Independence Avenue, SW

Washington, D.C. 20250­9410

fax:  (202) 690­7442; or

email:  program.intake@usda.gov.

This institution is an equal opportunity provider.

Do not fill out For School Use Only

Free Reduced Denied

Annual Income Conversion: Weekly x 52, Every 2 Weeks x 26, Twice a Month x 24 Monthly x 12Eligibility:How often?

Total Income Weekly Bi-Weekly 2x Month Monthly Household size

Categorical Eligibility

Determining Official’s Signature Date Confirming Official’s Signature Date Verifying Official’s Signature Date

Camper Name: ________________________ Age:_______ (as of June 20th)

Corps (or Service Extension County): _______________________________

2020 Music Camp

Music Camp is a working camp; daily activities will include vocal or instrumental lessons, as well

as musical theory and musical electives. Traditional “camp” activities will only be available

during choice time. Campers should be involved in their local Salvation Army. Campers who are

not involved in their local Salvation Army, or do not live near a Salvation Army, should have a

recommendation from their music teacher.

Select ONE Major Area of Study:

⃝ Choir Student

Can the camper read music? _________

⃝ Guitar Student

Has camper played guitar before? _____ If yes, for how long? _________________

Does the camper have a guitar he/she can bring to camp? _________

Can the camper read music? _________

⃝ Band Student Instrument: ________________

(Please note, band students MUST bring the instrument to camp, other than percussion students)

Has camper played this instrument before? _____ If yes, for how long? ______________

Can the camper read music? _________

Electives: Campers need to choose which music-type elective they will attend the whole week. Campers must choose 2nd & 3rd choices just in case their 1st choice is either full, or not enough participants to hold the class.

Drama Ukulele Percussion Ensemble Puppets Beginner Guitar* A/V Training (ages 12+) Dance Beginner Piano Song Writing (ages 12+) Painting Creative Writing Worship Leadership (ages 12+) Papercrafting

First Choice: _____________________________________

Second Choice: ___________________________________

Third Choice: _____________________________________ *Campers who are in the Guitar track may not take Guitar as an elective.