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JaM Camp Online Registration
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Where: Oakridge Camp and Retreat Center,
20007 OK-9, Anadarko, OK 73005
Child Camper Cost: $350
Teen Volunteer Cost: $200
Adult Volunteer Cost: $250
This covers all expenses for camp including a t-shirt and the snack shack.
When: June 24-27, 2022
Please be at the Northeast Church (
318 North Shiloh Road, Garland, TX 75042
) at
6:30 am on the 25th
. We will be leaving by bus at 7:00 am.
Breakfast snacks will be provided on the bus.
We will return to the Northeast Church by 6:00 pm Monday evening.
** If you have any questions, contact Blake Smith at 214.436.6388 or Katelyn Hoffman at 214.577.2443.
What type of registration would you like to complete?
(Required)
Adult Volunteer
Teen Volunteer
Child Camper
How many adult volunteers are you registering?
(Required)
One
Two
Three
How many teen volunteers are you registering?
(Required)
One
Two
Three
How many child campers are you registering?
(Required)
One
Two
Three
Person filling out the form
Name
(Required)
First
Phone Number
(Required)
Email Address
(Required)
First Adult Volunteer
Name
(Required)
First
Phone Number
(Required)
Email Address
(Required)
Date of Birth
(Required)
MM slash DD slash YYYY
Gender
(Required)
Male
Female
T-shirt size
(Required)
Youth XS
Youth S
Youth M
Youth L
Youth XL
Adult S
Adult M
Adult L
Adult XL
Adult 2XL
Adult 3XL
Which grade are you interested in serving?
(Required)
K-1
2-3
4-5
I am staff, sound team, etc.
Emergency Contact
Name
(Required)
First
Phone Number
(Required)
Relationship
(Required)
Health Insurance
Insurance Carrier
Policy #
Group #
Primary Doctor
Name
First
Phone Number
Date of Last Tetanus/TDaP Shot, if known (the CDC recommends adults get a Tetanus shot every 10 years)
MM slash DD slash YYYY
Please note any allergies and reaction type below (bees, insect bites, pollen, food, dietary restrictions, penicillin, other..). If none, please put "none"
(Required)
First Adult Volunteer Price
(Required)
Price:
Second Adult Volunteer
Name
(Required)
First
Phone Number
(Required)
Email Address
(Required)
Date of Birth
(Required)
MM slash DD slash YYYY
Gender
(Required)
Male
Female
T-shirt size
(Required)
Youth XS
Youth S
Youth M
Youth L
Youth XL
Adult S
Adult M
Adult L
Adult XL
Adult 2XL
Adult 3XL
Which grade are you interested in serving?
(Required)
K-1
2-3
4-5
I am staff, sound team, etc.
Emergency Contact
Use Previous Emergency Contact Details
Use same as previous Adult Volunteer
Name
(Required)
Name
First
Phone Number
(Required)
Phone Number
Relationship
(Required)
Relationship
Health Insurance
Use Previous Health Insaurance Details
Use same as previous Adult Volunteer
Insurance Carrier
Insurance Carrier
Policy #
Policy #
Group #
Group #
Primary Doctor
Use Previous Primary Doctor Details
Use same as previous Adult Volunteer
Name
Name
Phone Number
Phone Number
Date of Last Tetanus/TDaP Shot, if known (the CDC recommends adults get a Tetanus shot every 10 years)
MM slash DD slash YYYY
Please note any allergies and reaction type below (bees, insect bites, pollen, food, dietary restrictions, penicillin, other..). If none, please put "none"
(Required)
Second Adult Volunteer Price
(Required)
Price:
Third Adult Volunteer
Name
(Required)
Phone Number
(Required)
Email
(Required)
Date of Birth
(Required)
MM slash DD slash YYYY
Gender
(Required)
Male
Female
T-shirt size
(Required)
Youth XS
Youth S
Youth M
Youth L
Youth XL
Adult S
Adult M
Adult L
Adult XL
Adult 2XL
Adult 3XL
Which grade are you interested in serving?
(Required)
K-1
2-3
4-5
I am staff, sound team, etc.
Emergency Contact
Use Previous Emergency Contact Details
Use same as previous Adult Volunteer
Name
(Required)
Name
Phone Number
(Required)
Phone Number
Relationship
(Required)
Relationship
Health Insurance
Use Previous First Health Insaurance Contact Details
Use same as previous First Adult Volunteer
Insurance Carrier
Insurance Carrier
Policy #
Policy #
Group #
Group #
Primary Doctor
Use Previous First Primary Doctor Contact Details
Use same as previous First Adult Volunteer
Name
Name
Phone Number
Phone Number
Date of Last Tetanus/TDaP Shot, if known (the CDC recommends adults get a Tetanus shot every 10 years)
MM slash DD slash YYYY
Please note any allergies and reaction type below (bees, insect bites, pollen, food, dietary restrictions, penicillin, other..). If none, please put "none"
(Required)
Third Adult Volunteer Price
(Required)
Price:
First Teen Volunteer
Name
(Required)
First
Phone Number (optional)
Date of Birth
(Required)
MM slash DD slash YYYY
Gender
(Required)
Male
Female
T-shirt size
(Required)
Youth XS
Youth S
Youth M
Youth L
Youth XL
Adult S
Adult M
Adult L
Adult XL
Adult 2XL
Adult 3XL
Emergency Contact
Name
(Required)
First
Phone Number
(Required)
Relationship
(Required)
Health Insurance
Insurance Carrier
Policy #
Group #
Primary Doctor
Name
First
Phone Number
Date of Last Tetanus/TDaP Shot
(Required)
MM slash DD slash YYYY
Please note any allergies and reaction type below (bees, insect bites, pollen, food, dietary restrictions, penicillin, other..). If none, please put "none"
(Required)
Are there any factors that makes it advisable for this participant to follow a limited program of physical activity (i.e. heart condition, recent fractures, surgery, asthma, extreme fears, etc.)? If so,what? If none, put "none"
(Required)
Are there any PRESCRIPTION MEDICATIONS to be administered at camp?
(Required)
If "yes", you must print and complete the "Prescription Medication Authorization Form" attached to the registration confirmation email.
Yes
No
The following over-the-counter medications are available from the JaM Camp nurse. PLEASE CHECK MEDICATIONS BELOW FOR WHICH YOU GIVE PERMISSION for your child to take “as needed."
(Required)
Only medications that are CHECKED and determined to be necessary will be administered at the discretion of the camp nurse. Administration of these medications will be per label instructions unless otherwise indicated by the child's physician.
Tylenol (fever, discomfort)
Advil (fever, discomfort)
Throat Lozenges/Chloraseptic Spray (throat irritation, cough)
Benadryl (allergies)
Cortisone Cream Topical (skin irritation)
Visine - both regular & allergy (eye irritation)
Milk of Magnesia (constipation)
Imodium (diarrhea)
Sudafed (sinus congestion)
Tums/Pepto Bismol (heartburn/upset stomach)
None of the above
First Teen Volunteer Price
(Required)
Price:
Second Teen Volunteer
Name
(Required)
First
Phone Number (optional)
Date of Birth
(Required)
MM slash DD slash YYYY
Gender
(Required)
Male
Female
T-shirt size
(Required)
Youth XS
Youth S
Youth M
Youth L
Youth XL
Adult S
Adult M
Adult L
Adult XL
Adult 2XL
Adult 3XL
Emergency Contact (Second Teen Volunteer)
Use Second Teen Volunteer Emergency Contact
Second Teen Emergency Contact Same As First Teen
Name
(Required)
Name
Phone Number
(Required)
Phone Number
Relationship
(Required)
Relationship
Health Insurance (Second Teen Volunteer)
Use Second Teen Volunteer Health Insurance
Second Teen Health Insurance Same As First Teen
Insurance Carrier
Insurance Carrier
Policy #
Policy #
Group #
Group #
Primary Doctor (Second Teen Volunteer)
Use Second Teen Volunteer Primary Doctor
Second Teen Primary Doctor Same As First Teen
Name
Name
Phone Number
Phone Number
Date of Last Tetanus/TDaP Shot
(Required)
MM slash DD slash YYYY
Please note any allergies and reaction type below (bees, insect bites, pollen, food, dietary restrictions, penicillin, other..). If none, please put "none"
(Required)
Are there any factors that makes it advisable for this participant to follow a limited program of physical activity (i.e. heart condition, recent fractures, surgery, asthma, extreme fears, etc.)? If so,what? If none, put "none"
(Required)
Are there any PRESCRIPTION MEDICATIONS to be administered at camp?
(Required)
If "yes", you must print and complete the "Prescription Medication Authorization Form" attached to the registration confirmation email.
Yes
No
The following over-the-counter medications are available from the JaM Camp nurse. PLEASE CHECK MEDICATIONS BELOW FOR WHICH YOU GIVE PERMISSION for your child to take “as needed."
(Required)
Only medications that are CHECKED and determined to be necessary will be administered at the discretion of the camp nurse. Administration of these medications will be per label instructions unless otherwise indicated by the child's physician.
Tylenol (fever, discomfort)
Advil (fever, discomfort)
Throat Lozenges/Chloraseptic Spray (throat irritation, cough)
Benadryl (allergies)
Cortisone Cream Topical (skin irritation)
Visine - both regular & allergy (eye irritation)
Milk of Magnesia (constipation)
Imodium (diarrhea)
Sudafed (sinus congestion)
Tums/Pepto Bismol (heartburn/upset stomach)
None of the above
Second Teen Volunteer Price
(Required)
Price:
Third Teen Volunteer
Name
(Required)
First
Phone Number (optional)
Date of Birth
(Required)
MM slash DD slash YYYY
Genter
(Required)
Male
Female
T-shirt size
(Required)
Youth XS
Youth S
Youth M
Youth L
Youth XL
Adult S
Adult M
Adult L
Adult XL
Adult 2XL
Adult 3XL
Emergency Contact (Third Teen Volunteer)
Use Third Teen Volunteer Emergency Contact
Third Teen Emergency Contact Same As First Teen
Name
(Required)
Name
Phone Number
(Required)
Phone Number
Relationship
(Required)
Relationship
Health Insurance (Third Teen Volunteer)
Use Third Teen Volunteer Health Insurance
Third Teen Health Insurance Same As First Teen
Insurance Carrier
Insurance Carrier
Policy #
Policy #
Group #
Group #
Primary Doctor (Third Teen Volunteer)
Use Third Teen Volunteer Primary Doctor
Third Teen Primary Doctor Same As First Teen
Name
Name
Phone Number
Phone Number
Date of Last Tetanus/TDaP Shot
(Required)
MM slash DD slash YYYY
Please note any allergies and reaction type below (bees, insect bites, pollen, food, dietary restrictions, penicillin, other..). If none, please put "none"
(Required)
Are there any factors that makes it advisable for this participant to follow a limited program of physical activity (i.e. heart condition, recent fractures, surgery, asthma, extreme fears, etc.)? If so,what? If none, put "none"
(Required)
Are there any PRESCRIPTION MEDICATIONS to be administered at camp?
(Required)
If "yes", you must print and complete the "Prescription Medication Authorization Form" attached to the registration confirmation email.
Yes
No
The following over-the-counter medications are available from the JaM Camp nurse. PLEASE CHECK MEDICATIONS BELOW FOR WHICH YOU GIVE PERMISSION for your child to take “as needed."
(Required)
Only medications that are CHECKED and determined to be necessary will be administered at the discretion of the camp nurse. Administration of these medications will be per label instructions unless otherwise indicated by the child's physician.
Tylenol (fever, discomfort)
Advil (fever, discomfort)
Throat Lozenges/Chloraseptic Spray (throat irritation, cough)
Benadryl (allergies)
Cortisone Cream Topical (skin irritation)
Visine - both regular & allergy (eye irritation)
Milk of Magnesia (constipation)
Imodium (diarrhea)
Sudafed (sinus congestion)
Tums/Pepto Bismol (heartburn/upset stomach)
None of the above
Third Teen Volunteer Price
(Required)
Price:
First Child Camper
Name
(Required)
First
Date of Birth
(Required)
MM slash DD slash YYYY
Gender
(Required)
Male
Female
T-shirt size
(Required)
Youth XS
Youth S
Youth M
Youth L
Youth XL
Adult S
Adult M Adult L
Adult XL
Adult 2XL
Adult 3XL
Highest Grade Completed
(Required)
Kindergarten
First
Second
Third
Fourth
Fifth
Emergency Contact
Hidden
Child Camper Emergency Contact
Emergency Contact Same As In Adult Volunteer
Name
(Required)
First
Phone Number
(Required)
Relationship
(Required)
Health Insurance
Hidden
Child Camper Health Insurance
Health Insurance Same As In Adult Volunteer
Insurance Carrier
Policy #
Group #
Primary Doctor
Hidden
Child Camper Primary Doctor
Primary Doctor Same As In Adult Volunteer
Name
First
Phone Number
Date of Last Tetanus/TDaP Shot
(Required)
MM slash DD slash YYYY
Please note any allergies and reaction type below (bees, insect bites, pollen, food, dietary restrictions, penicillin, other..). If none, please put "none"
(Required)
Are there any factors that makes it advisable for this participant to follow a limited program of physical activity (i.e. heart condition, recent fractures, surgery, asthma, extreme fears, etc.)? If so,what? If none, put "none"
(Required)
Are there any PRESCRIPTION MEDICATIONS to be administered at camp?
(Required)
If "yes", you must print and complete the "Prescription Medication Authorization Form" attached to the registration confirmation email.
Yes
No
The following over-the-counter medications are available from the JaM Camp nurse. PLEASE CHECK MEDICATIONS BELOW FOR WHICH YOU GIVE PERMISSION for your child to take “as needed."
(Required)
Only medications that are CHECKED and determined to be necessary will be administered at the discretion of the camp nurse. Administration of these medications will be per label instructions unless otherwise indicated by the child's physician.
Tylenol (fever, discomfort)
Advil (fever, discomfort)
Throat Lozenges/Chloraseptic Spray (throat irritation, cough)
Benadryl (allergies)
Cortisone Cream Topical (skin irritation)
Visine - both regular & allergy (eye irritation)
Milk of Magnesia (constipation)
Imodium (diarrhea)
Sudafed (sinus congestion)
Tums/Pepto Bismol (heartburn/upset stomach)
None of the above
First Child Camper Price
(Required)
Price:
Second Child Camper
Name
(Required)
First
Date of Birth
(Required)
MM slash DD slash YYYY
Gender
(Required)
Male
Female
T-shirt size
(Required)
Youth XS
Youth S
Youth M
Youth L
Youth XL
Adult S
Adult M Adult L
Adult XL
Adult 2XL
Adult 3XL
Highest Grade Completed
(Required)
Kindergarten
First
Second
Third
Fourth
Fifth
Second Emergency Contact
Second Child Camper Emergency Contact
Use Emergency Contact Same As First Child Camper
Name
(Required)
First
Name
First
Phone Number
(Required)
Phone Number
Relationship
(Required)
Relationship
Second Health Insurance
Second Child Camper Health Insurance
Use Health Insurance Same As First Child Camper
Insurance Carrier
Insurance Carrier
Policy #
Policy #
Group #
Group #
Second Primary Doctor
Second Child Camper Primary Doctor
Use Primary Doctor Same As First Child Camper
Name
First
Name
First
Phone Number
Phone Number
Date of Last Tetanus/TDaP Shot
(Required)
MM slash DD slash YYYY
Please note any allergies and reaction type below (bees, insect bites, pollen, food, dietary restrictions, penicillin, other..). If none, please put "none"
(Required)
Are there any factors that makes it advisable for this participant to follow a limited program of physical activity (i.e. heart condition, recent fractures, surgery, asthma, extreme fears, etc.)? If so,what? If none, put "none"
(Required)
Are there any PRESCRIPTION MEDICATIONS to be administered at camp?
(Required)
If "yes", you must print and complete the "Prescription Medication Authorization Form" attached to the registration confirmation email.
Yes
No
The following over-the-counter medications are available from the JaM Camp nurse. PLEASE CHECK MEDICATIONS BELOW FOR WHICH YOU GIVE PERMISSION for your child to take “as needed."
(Required)
Only medications that are CHECKED and determined to be necessary will be administered at the discretion of the camp nurse. Administration of these medications will be per label instructions unless otherwise indicated by the child's physician.
Tylenol (fever, discomfort)
Advil (fever, discomfort)
Throat Lozenges/Chloraseptic Spray (throat irritation, cough)
Benadryl (allergies)
Cortisone Cream Topical (skin irritation)
Visine - both regular & allergy (eye irritation)
Milk of Magnesia (constipation)
Imodium (diarrhea)
Sudafed (sinus congestion)
Tums/Pepto Bismol (heartburn/upset stomach)
None of the above
Second Child Camper Price
(Required)
Price:
Third Child Camper
Name
(Required)
First
Date of Birth
(Required)
MM slash DD slash YYYY
Gender
(Required)
Male
Female
T-shirt size
(Required)
Youth XS
Youth S
Youth M
Youth L
Youth XL
Adult S
Adult M Adult L
Adult XL
Adult 2XL
Adult 3XL
Highest Grade Completed
(Required)
Kindergarten
First
Second
Third
Fourth
Fifth
Third Emergency Contact
Third Child Camper Emergency Contact
Use Emergency Contact Same As First Child Camper
Name
(Required)
First
Name
First
Phone Number
(Required)
Phone Number
Relationship
(Required)
Relationship
Third Health Insurance
Third Child Camper Health Insurance
Use Health Insurance Same As First Child Camper
Insurance Carrier
Insurance Carrier
Policy #
Policy #
Group #
Group #
Third Primary Doctor
Third Child Camper Primary Doctor
Use Primary Doctor Same As First Child Camper
Name
First
Name
First
Phone Number
Phone Number
Date of Last Tetanus/TDaP Shot
(Required)
MM slash DD slash YYYY
Please note any allergies and reaction type below (bees, insect bites, pollen, food, dietary restrictions, penicillin, other..). If none, please put "none"
(Required)
Are there any factors that makes it advisable for this participant to follow a limited program of physical activity (i.e. heart condition, recent fractures, surgery, asthma, extreme fears, etc.)? If so,what? If none, put "none"
(Required)
Are there any PRESCRIPTION MEDICATIONS to be administered at camp?
(Required)
If "yes", you must print and complete the "Prescription Medication Authorization Form" attached to the registration confirmation email.
Yes
No
The following over-the-counter medications are available from the JaM Camp nurse. PLEASE CHECK MEDICATIONS BELOW FOR WHICH YOU GIVE PERMISSION for your child to take “as needed."
(Required)
Only medications that are CHECKED and determined to be necessary will be administered at the discretion of the camp nurse. Administration of these medications will be per label instructions unless otherwise indicated by the child's physician.
Tylenol (fever, discomfort)
Advil (fever, discomfort)
Throat Lozenges/Chloraseptic Spray (throat irritation, cough)
Benadryl (allergies)
Cortisone Cream Topical (skin irritation)
Visine - both regular & allergy (eye irritation)
Milk of Magnesia (constipation)
Imodium (diarrhea)
Sudafed (sinus congestion)
Tums/Pepto Bismol (heartburn/upset stomach)
None of the above
Third Child Camper Price
(Required)
Price:
Payment
Total Amount Charge
*We will be sent a link later for payment.
