2026 KIDS Summer Camp Application

2026 Kids Summer Camp Application

Ages 7–12 | July 1 – July 4, 2026

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 20th
2. Provide payment: $140per child.
3. Submit a separate form PER child.

Important Notes

Transportation will be provided by school buses to and from the campsite

Additional details will be shared as the camp date approaches

Camp is for Sulamita Church members only

Children must be 7 years old by July 1st to attend

Participants Information

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.

Parent / Guardian Information

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.

Medical Information

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

Waiver & Agreement

Camp Waiver Link Doc

Confirmation & Payment

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 $140

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

2026 KIDS Summer Camp Application

2026 Kids Summer Camp Application

Important Notes

Description

Please Fix the Following