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To find a printable version of this inforrnation and the registration form go to:
www.penn-ierseydistrict.org and click'Ministries' then'Youth.'
For questions please contact: Penn-lersey District Youth Gamp Director
Rev. Justin Leininger - Phone: (61O) 767-f 239 - Email: justinl@bethanlrwes.org
 Penn-Jersey District Youth Compis for students going into
seventh grade through high schoolgroduotion.
our compoffers impoctful rollies & worship,connectionwith
Wesfeyoncolle-geteoms & other Wesleyonyouth, doytime ond
nighttime sports ond octivities, ond g?eat meals& snackshop.
Feel free ?o check out the swimmingpools,dinningoreos, ond
meetingplocesof our beoutiful compgroundsot
The Tuscarora Inn & Gonference Genter
Mt. Bethel, PA - 570-897-6000 - www.tuscarora.org

COMMUNITYSTANDARDS YOUTH CAMP COSTS

The followingcommunitystandardsare set by Tuscarora
Inn and/or Penn Jersey Youth Camp Staff. We believe Mailedby June 22nd- $225.00
these guidelineswill help you and othersenjoy the overall A non-refundabledepositof $100alongwith
camp expenence. the completedregistrationforms must be
postmarkedby June 1grh,2009.
Possessionand use of illegaldrugs,alcohol,and to-
baccois strictlyforbidden.
Prescription or over-the-counter drugsmustbe givento
Mailedby July zoth- $zzs.oo
the camp nurselor the safetyof yourselfand oth- A non-refundabledepositof $100alongwith
ers. the completedregictrationforme must be
Encouraginga positivecamp communityincludesno postmarkedby July 1lh, 2009.
fighting,swearing,disrespect and gossip.
All teens must be presentat all mealsand rallies.No
sleeping duringrallies.
MailedafterJuly 17rhlwalk-On - $325.00
Participation in public displaysof affectionmay be a At this point space is not guaranteed.
distractionto yourselfor othersand is not allowed
duringcamp. NOTE:ALL PAYMENTS must be receivedby
Stay within the camp boundariesand out of off limit augusTT6@u try to watk-onand
buildingsincludingbuildingsof the oppositesex.
Guys and Girls are to dress modestly by not wear-
register(spacenot guaranteed).
ing two-piecesuits or Speedos. Undergarments
are not lo be visibleiskirtsmusttouchthe too of
yourkneesin a standingposition.Guysmustwear FAMILY ASSISTANCE
shirlswhennot swimmino.
Must be received by July 6, 2009.
lf a family has two or more teens aftending
W H AT T O BR IN G T O C AMP camp we may offer a reducedrate to help
o with the cost of camp. To be eligiblethe
Bible.notebook.& oen
applicantmust fill out the Assistance
o Toiletries(deodorant, towels,gel, Application beforethe registrationdeadline.
toothbrush,etc)
o Sleepingbag & pillow lf accepted,registrationsmust be in with your
o Swim Suit (no 2-piece) depositby July 20,2009.Ratesare as follows:
o Plentyof clothingfor five days ; t'/i<tt,.i.t-,L,rat, [two teens $400,three teens $500,four teens
o Moneyfor snackshop
$6001A non -refundabledepositof $100x the
i* ,tL.,,
'""Y" number of teens along with the completedreg-
. Sunscreen& bug repellent "/o
istration forms are due by July 20, 2009.The
o Alarmclocksare allowed- we suggestleaving remainingbalancewill be due on or before
all otherelectronicdevicesaI6ome (CD " Mon.Aug.1oth,2009.
players,TVs, game systems, phones)cell

PleaseNote: TuscaroraInn and the

Penn-JerseyDistrict is not responsiblefor OTHERINFORMATION
lost or stolen items. Any itemsfound -Camp registration is conducted between
distractingto campwill be takenaway. 1:00PMand 3;00PM,Mon.Aug.17th
(Thisespeciallyincludescell phones!) -Campconcludesfollowingthe noon ireal
on Fri.Aug. 21"'
 CAMPER
REGISTRATION
Gamper'sName

Address

City State_ Zip

Church

Age_ M/F

T-ShirtSize(S- XXXL)

I grantpermission for my son/daughter

to attendthe
Penn-Jersey DistrictYouthCamp,August17th-21"t.
Relation to Camper.
Signature, Date / /

WaterActivities
I grantpermission for my son/daughter
to participate
in supervisedwaterfront
andwateractivities.
Signature. Date //

Regi stration DeadIi n es:

(Postmarkedby thesedates)
Monday, June 2fo for the $225 cosf
Monday, July 20thfor the $275 cosf
Anything postmarkedaftelJuly 17thwllt be considereda walk on
registrationat $325
ALL PAYMENTSMUSTBE RECEIVEDBEFORE
MONDAY,AIJGTTST lOTH!

Pleasemail registrationform and a minimumof $100depositto:

PastorShannonD'Agostino
443WalnutStreet
Millersburg,PA 17061
Please make checks payable to: Penn-Jersey District Youth
 Medical ReleaseForm

Camper'sName
Parent/ Guardian
Phone(day) (night)
Cell#
Do you havemedicalinsurance? _yes _no
Company
Group# Policy#
In case of an emergencyor injury,the hospitalwill not treat unlesspermissionhas
been granted by phone from the parent or other relative. Please list additional
phonenumberswhereyou or anothercloserelativecan be reachedday or night.
Nameof additionalrelative(s)

Relationship Phone
FamilyDoctor
Address/ phone

Pleasecheckall thatapplv:
_Nose bleeds_Upset Stomach_Bed Wetting
_Convulsions_Rheumatic Fever_Diabetes
lnfections:
_Eye _Ear _Nose _Throat
Allerqies:
Asthma Hay Fever_lnsect Stings
_Penicillin _Drug/Food(specify)
Other

Dietaryrestrictions
Activityrestrictions
Dateof lastTetanusshot
Medications that must be taken

This is for the followingcondition(s)

Whenis the medication
to be taken?
Doesthe medicationhaveside affects?
lf yes,whatcanbe doneto preventthis?

In theeventthatthechildbecomes illor injuredI givepermissionforthenecessary

treatmentat the nearestmedicalfacilityandfortransportation
to thatfacility.
ParenUGuardian Signature