2025 Kids Summer Camp Application

Kids (Age 7-12) July 2nd – July 5th

Camp Location:
Conference & Retreat Center
5605 Jubilee Dr SE, Turner, OR 97392

If you have any questions please call:
Luba Shargarodskaya 503-888-0643
Yelena Karnafel 360-798-5962

Instructions:
1. Complete form by May 17th.
2. Provide payment: $135 per child.
3. Submit a separate form PER child.

Notes:
School buses will be used for transporting kids to and from campsite, please be on a lookout for more announcents.

Please note, our summer camps are for Sulamita Church members only, and children must be at least 7 years old by July 1st in order to attend.

Name

Child's First and Last Name

Address

Gender

Male Female

Date of Birth

Age at time of camp

7 (Must be 7 by July 1st) 8 9 10 11 12

T-shirt size:

XS S M L XL

T-shirts are youth sizes.

Father's Name

Father's Phone Number

Mother's Name

Mother's Phone Number

Other Emergency Phone Contact (if parents are not responding)

What church are the parents of the applicant members of?

Sulamita Other

If other, please provide the name:

Please note, our Summer camps are for members only.

Does applicant have allergies to any medications?

None Claritin Visine (eye drops) Tylenol Ibuprofen Benadryl Other

List which medicine the applicant is allergic to:

Does applicant have any seasonal/other allergies?

Yes No

If yes, list them:

Will your child bring any medications from home?

Yes No

If yes, which:

My child may be administered the following medicine if necessary by camp staff:

Yes No

-Tylenol (Acetaminophen)(pain reliever)

-Ibuprofen (Motrin/Advil)(pain reliever)

-Cough drops

-Claritin (Loratadine)( allergy medicine)

-Zyrtec (Cetirizine)(allergy medicine)

-Antihistamine (Benadryl)(allergy medicine)

-Hydrocortisone Cream (itching/poison ivy)

-First Aid Antibiotic cream( minor cuts and scrapes)

-Pepto Kids (acid indigestion/heartburn)

-Calamine lotion (skin protectant-poison oak)

-Kids Sleep (melatonin/L-Theanine & Botanicals)
-Kids probiotics (kids gummies)(helps digestive/immune support/vitamin C boost)

-Visine eye drops ( allergy eye relief multi-action)

Specify any special medical conditions/etc. which staff should be aware of:

None Health/Physical/Medical Eating Sleeping Swimming Other

If other, please list

Camp Waiver Link Doc

By checking here, you certify that you have read and agree to the above waiver.

This address will receive a confirmation email

Electronic Signature (Participant's Full Name or Full Name of Legal Guardian if Participant is Under the Age of 18)

Kids Camp Registration

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

2025 Kids Summer Camp Application

Description

Please Fix the Following