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JaM Camp 2023 Registration
Hidden
PriceAdult
(Required)
Hidden
PriceTeen
(Required)
Hidden
PriceChild
(Required)
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:
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
Person filling out this 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)
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 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/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
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 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/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 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
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/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
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/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
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
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/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
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/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
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 credit or debit card
Full amount with cash or check (payable to "JaM Camp")
Payment plan and/or scholarship
Payment
How much can you pay today?
(Required)
Please describe your plan for paying the remainder.
(Required)
TODO: list examples here
[invisible CostAdjust]
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
[PayNowAmount calculation]
If the payment plan page was shown earlier, this will equal the amount entered there (and that page will include a price field to negate the original "total cost of camp" price field). Otherwise, this field will be 0, leaving the original "total cost of camp" to be charged. This calculation is used to show/hide the remaining fields below. They will not be shown at all if the payment plan page was shown and the user entered 0 there.
Would you like to contribute $5/person to help offset credit/debit card processing fees?
Quantity
(Required)
Price:
$5.00
Quantity
Amount to charge
Credit/Debit 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 Calculation]
for the email notification
Click the button below to submit your registration for JaM Camp. We look forward to seeing you there!
