Youth Ministries Rodeo Bible Camp                                                                                                                                                                                                                                 

2012 Registration Packet for WWM Rodeo Bible Camp'

June 5 - 8 - 2012 -- Ike Hamilton Expo Center - West Monroe, LA 

To register for Rodeo Bible Camp you must be age 8 to 18 and send the following by May 25^th  to:  Wagon Wheel Ministries - 605 Old Arkansas Road - Calhoun, LA 71225

*Camp tuition (Children age 8 to18) - $300.00

*Registration Packet - All 6 pages of information completed with proper signatures of                                       

                                      parents/legal guardian, camper, and notary (Keep an extra copy of pages 5 & 6).                             

T-shirt size ( circle one) Child:  XS  S  M  L  XL  XXL        Adult:  S  M  L  XL  XXL  XXXL

Have you ever been to a rodeo camp before?_________    If yes, when/where__________________

(Office use only)  Medical Alert - Allergies:___________________________________________________

 Event_________________________ Stall #______ Team Leader__________________________________

 (Page 2)

Camper's Name   ________________________________________________________________

Horse's name, current coggins, and health certificate will be required for identification purposes.

How long have you been riding & caring for this horse?_________________________

What is your riding experience?____________________________________________

Have you participated in a rodeo as a contestant?    Yes____    No____

If yes, when/where______________________________________________________

If no, will this be your first time in rough stock or timed events?__________________

Do you have or have you had any injuries in the last 6 months?   Yes____    No____

If yes, please explain_____________________________________________________

Are you taking any medications prescribed by a physician?   Yes____    No____

If yes, please list & explain reason__________________________________________

(Page 3)

2012 Registration Packet - Health Form

MEDICAL INFORMATION FOR CAMPER:  (Name)_________________________________

ALLERGIES: ___________________________________________________________________

Note to Parents:  We strongly advise that you have INDIVIDUAL HEALTH INSURANCE to protect your child.  Every precaution will be taken to ensure your child's stay with us is a fun and safe experience.  In the event of an accident, you will be notified immediately.  Please fill out the following Health Form completely and accurately as reference for our nursing staff.

Hospitalization/Insurance Company__________________________________________________

Group or Policy No._______________________________________________________________ (A copy of health insurance card (front & back) is required with application.)

Doctor's Name___________________________________________ Phone___________________

Please list any medication that your child will bring to camp:

(Include prescription and non-prescription medications such as aspirin, vitamins, etc)

Medication__________________    Dosage___________________    Reason__________________

Medication__________________    Dosage___________________    Reason__________________

Medication__________________    Dosage___________________    Reason__________________

Medication__________________    Dosage___________________    Reason__________________

Does your child have seizures?  YES____    NO____     If yes, most recent occurrence___________

Medication for seizures______________   Dosage___________ Special precautions_____________

Has your child ever been knocked unconscious or passed out?   YES____     NO____

If yes, when and how?______________________________________________________________

The date your child last saw a physician____________ Physician's name_____________________

Reason for the visit________________________________________________________________

Year of last Tetanus shot_____________

Does your child have a history of: Heart Problems? YES____ NO____  Diabetes? YES___   NO__

List any other helpful medical information that will assist in the management of your child's safety:

________________________________________________________________________________

HEALTH RELEASE

This health release must be signed by a parent or legal guardian & sent with registration.

This health history is correct as far as I know.  In case I cannot be reached, I hereby give permission to medical personnel with proper credentials to give emergency treatment to:

Camper's Name_______________________________________ SS#________________________

Signed__________________________________________________________________________

                                                                 Legal guardian of minor child                                                                        

Notary_________________________________________________Date_____________________

(Page 4)

 2012 Registration Packet - Liability Release

Camper's Name ________________________________________________________________________    __    I have discussed the event I wish to participate in with my parent(s) or legal guardian, and they have explained to me the possibility of my being slightly and/or severely injured.  My parent(s) or legal guardian and I are willing to assume the responsibility of possible injury that could result from the event in which I will be participating.                                                                                                                                                                           I further agree that should I feel endangered at any point, either by my own actions, the actions of others, or by any surrounding circumstances, that I am free to with draw from the event and will do so of my own free will.  Once I have made the decision to enter an event, I understand I cannot change my event once my parents leave the premises.  I only have the option of dropping out of the event which they have signed off for me to enter.  I voluntarily assume the risk inherent to this event and I do so of my own free will.

Name of Minor Participating_________________________________________________________

Signature_________________________________________________ Date___________________

I undersigned parent(s) or legal guardian, have read and voluntarily sign the assumption of risk form and further agree that no oral representation, statements, or inducements apart from the forgoing written agreement have been made.

Parent(s) or Legal Guardian_________________________________________________________

Signature________________________________________________ Date____________________

Release of Liability 

As the parent(s) or legal guardian of the aforesaid child, we do hereby give permission for said child to participate in the rodeo events and activities of Wagon Wheel Ministries Rodeo Bible Camp.  We release their agents, officers, directors, volunteers or any other person acting on their behalf from claims and judgment which the above named ever had, or now has, or may have in the future for all personal injuries or property damage that may be suffered by participation.  We have done so fully understanding that rodeo is a hazardous sport, which could lead to serious injury and in some cases death.  In giving my permission for my child to participate in the camp activities, we give permission for any medical treatment that may be necessary and release and understand its significance.

Signature________________________________________________________________________

                                                        Parent(s) or Legal guardian                                                                                                                                           

Notary Signature__________________________________________________________________

(Page 5)

2012 WAGON WHEEL MINISTRIES RODEO BIBLE CAMP

RULES FOR CAMPERS

1. Campers are required to attend and remain at all scheduled activities.

2. Campers are expected to be prompt at all meals, meetings, and activities unless excused by the Camp Director.

3. In between clinic times and meal times, campers must stay on designated areas of camp

grounds. NO EXCEPTIONS!

4. No riding of horses except during clinic times.

5. No roping of any person or horse allowed.

6. No roping or rough-housing allowed in the building.

7. Horses must remain in area of Horse Barn, Arena, & Pens.

8. Campers are required to stay in their sleeping quarters from the time of "lights out" until

morning wake up except for special emergency: BOYS MUST REMAIN in boys' area. Girls

MUST REMAIN in girls' area.

9. We encourage Christ-honoring relationships between boys and girls. Don't touch!

10. Use of phones FOR EMERGENCY ONLY. See staff member before using a telephone.

11. Every camper is responsible for his/her own personal belongings.

12. Any camper defacing camp property must pay for the damage incurred.

13. It is expected that everyone will dress in a manner which is pleasing to God and does not draw

unnecessary attention to oneself. Direct any questions in this area to your counselor.

14. Radios, cassette players, and IPODS are not permitted in camp.

15. No snacks or food, especially in the barns. They attract all kinds of critters, particularly ants.

A locked snack food trailer will be available for snack storage to prevent bugs.

16. Any case of illness, injury or infection must be reported at once. Failure to do so may

jeopardize any claim for insurance.

17. Everyone is expected to stay at camp until pictures are taken and awards are presented

following the conclusion of the rodeo on the last day.

18. Campers are permitted to leave the grounds only with the permission of the Camp Director.

Come and have fun learning rodeo skills AND practicing how to be a

CHAMPION IN AND OUT OF THE ARENA!

*********************************************************************************************

**I have read & will abide by these rules & know I will be sent home if I do not!

Camper's signature_____________________________________________________

**I have read & expect my child to abide by these rules and know I will be called

     to come & get him/her if he/she does not!

Parent/Guardian's signature______________________________________________   

(Page 6)

2012 WAGON WHEEL MINISTRIES RODEO BIBLE CAMP

WHAT TO BRING TO CAMP:

What should I bring to camp?

A key to a successful camp experience for your camper is to make sure that they come prepared.

Check our list below to assist you and your child with bringing everything they will need for camp.

Jeans

Towels

Shorts

Personal items

Tennis shoes

Small notebook

Bug spray

Pen/pencil

Sunscreen

Sleeping bag/pillow/cot

Rodeo clothes - All necessary horse and event gear

(Boots, hat, long sleeved shirt & necessary clothing)

Be sure your kids take home all that they brought with them to camp. We suggest you mark all of their items ahead of time. We also suggest you check the sleeping areas, arena, and stall areas before leaving.

WHAT NOT TO BRING TO CAMP:

No personal valuables should be brought to camp! WWM will not be responsible for lost or stolen items.

DO NOT bring knives, tobacco products, illegal drugs, cards, TV, radio, or video games to camp. We also ask that cell phones not be used during the day.

NO dogs, stud horses, or mares with colts, please!

IS THERE A DRESS CODE WHILE AT CAMP?

In order to promote a positive environment at camp, WWM requires that all campers and team

leaders adhere to the following guidelines while attending camp. All clothing worn by campers and

leaders should be modest and in good taste. In some cases, we may ask campers who are wearing questionably immodest clothing (i.e. very short shorts, tight or see through clothing, cropped shirts or shirts that do not cover their middle, excessively low-riding or tight jeans, etc.) to change. Please be sure your camper packs appropriately.

*********************************************************************************************

**I have read & will abide by these rules & know I will be sent home if I do not!

Camper's signature_______________________________________________________________

**I have read & expect my child to abide by these rules & know I will be called to come & get him/her if not!

Parent/Guardian's signature_______________________________________________________