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JaM Camp 2023 Registration
Hidden
PriceAdult
(Required)
NOTE: Also manually update [Camp Information] HTML below when there is a price change
Hidden
PriceTeen
(Required)
NOTE: Also manually update [Camp Information] HTML below when there is a price change
Hidden
PriceChild
(Required)
NOTE: Also manually update [Camp Information] HTML below when there is a price change
Where: Oakridge Camp and Retreat Center,
20007 OK-9, Anadarko, OK 73005
Child Camper Cost: $400
Teen Volunteer Cost: $225
Adult Volunteer Cost: $300
This covers all expenses for camp including a t-shirt and the snack shack.
When: June 23-26, 2023
Please be at the Northeast Church (
318 North Shiloh Road, Garland, TX 75042
) at
6:30 am on the 23rd
. 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.
If you have already registered and need to make a payment, you can do that directly via Stripe here:
If you would just like to make a donation to JaM Camp, you can do that directly via Stripe here:
Click below to fill out registration forms:
Person filling out this form
Name
(Required)
First
Phone Number
(Required)
Email Address
(Required)
How many people are you registering?
Adult Volunteers
(Required)
0
1
2
3
Teen Volunteers
(Required)
0
1
2
3
Child Campers
(Required)
0
1
2
3
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)
We encourage parents to sign up for a different group than the group their child(ren) will be in. While not mandatory, we have seen this be beneficial for our campers as they take a step in their own spiritual growth and build peer relationships.
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 Shot (Tdap/DTaP/DT/Td), 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
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)
We encourage parents to sign up for a different group than the group their child(ren) will be in. While not mandatory, we have seen this be beneficial for our campers as they take a step in their own spiritual growth and build peer relationships.
K-1
2-3
4-5
I am staff, sound team, etc.
Emergency Contact
Use Previous Emergency Contact Details
Use same as First Adult Volunteer
Name
(Required)
Name
First
Phone Number
(Required)
Phone Number
Relationship
(Required)
Relationship
Health Insurance
Use Previous Health Insaurance Details
Use same as First Adult Volunteer
Insurance Carrier
Insurance Carrier
Policy #
Policy #
Group #
Group #
Primary Doctor
Use Previous Primary Doctor Details
Use same as First Adult Volunteer
Name
Name
Phone Number
Phone Number
Date of Last Tetanus Shot (Tdap/DTaP/DT/Td), 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
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)
We encourage parents to sign up for a different group than the group their child(ren) will be in. While not mandatory, we have seen this be beneficial for our campers as they take a step in their own spiritual growth and build peer relationships.
K-1
2-3
4-5
I am staff, sound team, etc.
Emergency Contact
Use Previous Emergency Contact Details
Use same as First 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 First Adult Volunteer
Insurance Carrier
Insurance Carrier
Policy #
Policy #
Group #
Group #
Primary Doctor
Use Previous First Primary Doctor Contact Details
Use same as First Adult Volunteer
Name
Name
Phone Number
Phone Number
Date of Last Tetanus Shot (Tdap/DTaP/DT/Td), 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 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 Shot (Tdap/DTaP/DT/Td)
(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
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
Use Second Teen Volunteer Emergency Contact
Use same as First Teen Volunteer
Name
(Required)
Name
Phone Number
(Required)
Phone Number
Relationship
(Required)
Relationship
Health Insurance
Use Second Teen Volunteer Health Insurance
Use same as First Teen Volunteer
Insurance Carrier
Insurance Carrier
Policy #
Policy #
Group #
Group #
Primary Doctor
Use Second Teen Volunteer Primary Doctor
Use same as First Teen Volunteer
Name
Name
Phone Number
Phone Number
Date of Last Tetanus Shot (Tdap/DTaP/DT/Td)
(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
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
Use Third Teen Volunteer Emergency Contact
Use same as First Teen Volunteer
Name
(Required)
Name
Phone Number
(Required)
Phone Number
Relationship
(Required)
Relationship
Health Insurance
Use Third Teen Volunteer Health Insurance
Use same as First Teen Volunteer
Insurance Carrier
Insurance Carrier
Policy #
Policy #
Group #
Group #
Primary Doctor
Use Third Teen Volunteer Primary Doctor
Use same as First Teen Volunteer
Name
Name
Phone Number
Phone Number
Date of Last Tetanus Shot (Tdap/DTaP/DT/Td)
(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
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 Shot (Tdap/DTaP/DT/Td)
(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
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
Second Child Camper Emergency Contact
Use same as First Child Camper
Name
(Required)
First
Name
First
Phone Number
(Required)
Phone Number
Relationship
(Required)
Relationship
Health Insurance
Second Child Camper Health Insurance
Use same as First Child Camper
Insurance Carrier
Insurance Carrier
Policy #
Policy #
Group #
Group #
Primary Doctor
Second Child Camper Primary Doctor
Use same as First Child Camper
Name
First
Name
First
Phone Number
Phone Number
Date of Last Tetanus Shot (Tdap/DTaP/DT/Td)
(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
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
Third Child Camper Emergency Contact
Use same as First Child Camper
Name
(Required)
First
Name
First
Phone Number
(Required)
Phone Number
Relationship
(Required)
Relationship
Health Insurance
Third Child Camper Health Insurance
Use same as First Child Camper
Insurance Carrier
Insurance Carrier
Policy #
Policy #
Group #
Group #
Primary Doctor
Third Child Camper Primary Doctor
Use same as First Child Camper
Name
First
Name
First
Phone Number
Phone Number
Date of Last Tetanus Shot (Tdap/DTaP/DT/Td)
(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
Payment
Hidden
[adult price subtotal]
(Required)
Hidden
[teen price subtotal]
(Required)
Hidden
[child price subtotal]
(Required)
Your Total Cost of Camp
Price:
$0.00
How would you like to pay?
(Required)
Full amount now with a debit or credit card
Full amount with cash or check (payable to "JaM Camp")
Payment plan and/or scholarship
Payment
We do not want the cost of camp to prohibit any child from attending. A limited amount of scholarship money is available for those who cannot pay the full cost for their camper(s) and it will be distributed based on financial situation and need.
How much can you pay now (with debit/credit card)?
(Required)
You may enter 0 here if you are not able to make a debit/credit card payment today.
Please describe your plan for paying the remainder.
(Required)
Some families choose to pay half now and half in one month while others choose to pay $100 per month until they have paid the full amount. Please describe a payment plan that fits your family's budget. If you will not be able to pay the full amount for your camper(s), please state how much you can pay (including the amount you entered above) and write a brief statement about your situation to help us understand the need.
[invisible CostAdjust for partial payment]
Pricing field to negate the subtotal pricing field allowing for the user-entered price above to be the only amount charged at this time.
Price:
$0.00
Payment
[invisible PayNowAdjFull]
If the full payment now option was selected, this field will hold the Subtotal, else 0. Thus, either this field or the PayNowAmountPrice field (on the previous page) will always be 0 and when cash pay was selected, they will both be 0. These facts are important for how the PayNowAmount calculation field below computes the correct amount.
[invisible PayNowAmount calculation]
Computes the total payment being made now, using the facts mentioned in the PayNowAdjFull field to properly handle the 3 scenarios. This calculation is also used to show/hide the remaining fields below. They will not be shown if the user selected cash pay or selected partial pay but entered 0.
Would you like to contribute $5/person to help offset debit/credit card processing fees?
Quantity
(Required)
In the Quantity box, enter the number of people you are registering (or the number you would like to help offset fees for).
Price:
$5.00
Quantity
Amount to charge
Debit/Credit Card
(Required)
Card Details
Cardholder Name
[invisible CC Fees Total Calculation]
For the email notification.
[invisible Amount Paid Now Calculation]
For the email notification.
[invisible Remaining Amount Due]
For the email notification.
Click the button below to submit your registration for JaM Camp. We look forward to seeing you there!
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