Summer Camp 2026 Staff Registration and Health Forms

  • Summer Camp 2026 Staff Registration and Health Forms - Important Instructions 
     

    PLEASE READ THROUGH THE INSTRUCTIONS COMPLETELY - DO NOT SKIP!!

     

    ***Note: If you are Under 18 years old at the time of this registration you need to have a parent or guardian help you complete your registration for People of God Summer Camp 2026.

    Please complete the google form to complete registration for your child for People of God Summer Camp 2026. The health form and waivers are also included in this online form and must be completed. Please be sure to have all the needed medication names, medical history, insurance information, credit card, etc. on hand before beginning the form if possible. Payment is due before form can be submitted!

    Due to the conditional formating of this form! It will work best if completed from top to bottom (the first question to the second question and so forth - except when clicking save). Please do not jump around the document. Answer the questions one at a time and in order, and you will save yourself many headaches. You can always come back and reread this instruction page. 

    *** After completing the basic contact info and after you answer the "email address" question please take a moment scroll to the bottom of the form and click "Save" this will allow you to pick up where you left off, should you be unable to finish the form. If you do not hit SAVE periodically, your progress will be lost. After hitting save you will be prompted with a Jotform popup (it may look like the image below if you have not filled out a jotform before). You do not need a jotform account to save the document simply choose the option that sends a link to your email for easy access to the form. This is in small blue print and says "Skip Create an Account". You can then enter the email that you want Jotform to send the access link to. Make sure to check your junk mail if you do not see it immediately. Upon the completion of more questions, make sure to hit "Save" once more before exiting the form. And do not forget to hit "Submit" at the very end of the form.

     

     

      

     

    Proceed through the registration until you see the screen below. Your responses have not been submitted until you see the following screen!!!

     

     

     

     

    If you have any questions, please email pogcamp@gmail.com.

    Joel Pepmeyer, Seth Porterfield, and Beth Mayer

  • Registration Information

    Head and assistant cabin counselors may be provided info pertaining to Junior Counselors in order to help us serve your children in the best possible way this week at camp. If you have questions, please save your progress and email pogcamp@gmail.com
  • Which type of staffer are you registering?*
  • Birth Date*
     - -
  • Sex*
  •  -
  • Community Affiliation (if applicable)*

  • Staffer Health Form Information

    This health information will go directly to our nursing staff.
  • Format: (000) 000-0000.
  • Has/does the staffer have: (check all that apply)*
  • We would like to do our best to support our staffs mental health while at summer camp. Please check any that apply below being as specific as you can. (*If you or your child take a break from medications during the summer, we do suggest you consider resuming them for the week of summer camp, due to the rigorous schedule of summer camp.)*

  • Consider Clicking "Save" at this point - your progress will be saved to the link that Jotform previously sent you via email

  • Does the staffer have any allergies? (medicine, environmental, food, etc.)*

  • Allergy Information

  • Does the staffer carry an epipen?

  • Additional Allergy Information

  • Asthma

  • Does the staffer have asthma?*
  • Does the staffer carry a rescue inhaler (for asthma or any other reason)?*

  • Immunization Information

  • Date of last Tetanus shot*
     - -
  • Is the Junior staffer up to date with all the vaccinations required by your local school district?

  • If there is an outbreak of a communicable disease you will be contacted and made aware of the situation

  • Medications

    Please list all prescription and any over the counter medications (you/your child) takes. Don't forget to include inhalers and/or epipen. You must include the following: MEDICATION NAME, DOSE (total # of pills/dose and mg/dose), FREQUENCY, TIMES NORMALLY TAKEN AT HOME, REASON, and IF THE MEDICATION SHOULD BE TAKEN AS NEEDED. Please simply list N/A (for Medication #1) if you do not have medication needs.

  • All prescription medication must be brought to camp in a current and correctly labeled prescription bottle(s) and all over the counter medication must be in its original packaging!!

  • Additional Medications

    If you will be bringing more than six medications to camp, please email this additional information to Sarah Gold, camp nurse. Email address is sjg3232@gmail.com

  • Illness Protocol

  • Consider Scrolling Down and Clicking "Save" at this point - your progress will be saved to the link that Jotform previously sent you via email

  • Pre-Camp Training

    All of our staff (regardless of how many years you have previously served) need to review our pre-camp training videos. These are important trainings so that we are all on the same page heading into our week at camp. All staff serving at camp for the first time will also have to undergo our Child Protection Policy training and familiarize themselves with our Child Protection Policy
  • I (the staffer) understand that I will be required to participate in reviewing the training videos prior to camp.*
  • Do you have a valid lifeguard certification?*
  • I understand that I will not be permitted to serve at camp unless I have all the needed youth work clearances as outlined by the People of God Child Protection Policy*

  • Saturday Night Lord's Day

    Staff are asked to report to All Saints Camp on Saturday July 11th (we understand this is not possible for all staff, especially those traveling from out of state, but we ask that you prioritize this and at the very least please be on site before our staff training at 9am on Sunday morning). Saturday evening, we celebrate Lord's Day together and order food for dinner. We ask staff to donate around $5 cash to help cover the cost of Saturday's dinner. A light meal will be provided Sunday morning, but there is also a truck stop restaurant in town that staff can go to before training as well.
  • Please check the option below that best matches your plans for Saturday evening so that we can plan accordingly. I will...

  • Insurance Information

    If you do not have traditional health insurance , put NA in the required boxes and explain in the "any other info we should know" box below
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Electronic Signature

    By electronically signing your name below, you are verifying that all information included in this form and heath record is accurate to the best of your knowledge. Any changes in information prior to arrival at Summer Camp will need to be communicated with the directors and/or the nurse via the email address pogcamp@gmail.com . I also understand that all prescription medication must be brought to camp in a current and correctly labeled prescription bottle(s) and all over the counter medication must be in its original packaging.

  • Waivers

    Below you will find our waivers/releases for camp. It is your job to read them in their entirety, so you know what you are signing. By signing electronically, you are agreeing that your electronic signature will serve as your physical signature, and you agree to be bound by the contents of the following waivers/releases which you have filled out. One signature shall be collected for the whole collection of waivers and releases. The permissions this signature entails will apply to the child this form has been filled out for.

  • WAIVER OF LIABILITY

    I, hereby undersigned, have given permission for my child to attend the People of God Summer Camp from July 11, 2026 through July 18, 2026 at All Saints Ukrainian Orthodox Camp.

     I agree to waive any claims against the People of God and its appointed camp personnel based on any theories of recovery in law and equity. Further, I agree to indemnify and hold harmless the People of God and its authorized agents and representatives from any and all costs and expenses such as attorney’s fees, costs of investigation or discovery, court costs, and other sums in connection with any legal claim or action arising from my child’s use of real or personal property of the People of God and the All Saint’s Campground.

  • Do you consent?*

  • ADULT WAIVER OF LIABILITY

    I plan to attend the People of God Summer Camp from July 11, 2026 through July 18, 2026 at All Saints Ukrainian Orthodox Camp.

     

    I agree to waive any claims against the People of God and its appointed camp personnel based on any theories of recovery in law and equity. Further, I agree to indemnify and hold harmless the People of God and its authorized agents and representatives from any and all costs and expenses such as attorney’s fees, costs of investigation or discovery, court costs, and other sums in connection with any legal claim or action arising from my use of real or personal property of the People of God and the All Saint’s Campground.

     

  • Do you consent?*

  • AUTHORIZATION OF CONSENT TO TREATMENT

    I give permission on behalf of my minor child to all authorized agents and representatives of the People of God to give, obtain and consent to both routine and emergency health care.  In case of emergency, I understand every effort will be made to contact me.  In the event I cannot be reached, I hereby give specific consent in advance to the physician or surgeon selected by an adult representative of the People of God to secure any and all proper treatment, including hospitalization, x-ray examination, anesthesia, surgery, or injections of medication for my son or daughter, whether such treatment is administered at the office of said physician or at a hospital.  I give permission to the camp to provide transportation related to any health needs of my child and I agree to the release and/or photocopying of any records for the purposes of treatment, referral, billing or insurance.

  • Do you consent?*

  • ADULT AUTHORIZATION OF CONSENT TO TREATMENT

    I give permission to all authorized agents and representatives of the People of God to give, obtain and consent to both routine and emergency health care.  In case of emergency, I understand every effort will be made to contact my emergency contact.  In the event they cannot be reached, I hereby give specific consent in advance to the physician or surgeon selected by an adult representative of the People of God to secure any and all proper treatment, including hospitalization, x-ray examination, anesthesia, surgery, or injections of medication for myself whether such treatment is administered at the office of said physician or at a hospital.  I give permission to the camp to provide transportation related to any health needs and I agree to the release and/or photocopying of any records for the purposes of treatment, referral, billing or insurance.

  • Do you consent?*

  • Media/Photo Release

    I hereby agree and consent to the use of any photograph, voice recording or videotape of the minor named above for promotional purposes on behalf of the People of God Summer Camp.  This may include, but not be limited to, brochures, web sites, videos and slide shows.  All rights and interest in the finished product are relinquished and all rights to payment or compensation are waived.

  • Do you consent?*

  • Adult Media/Photo Release

    I hereby agree and consent to the use of any photograph, voice recording or videotape of myself for promotional purposes on behalf of the People of God Summer Camp.  This may include, but not be limited to, brochures, web sites, videos and slide shows.  All rights and interest in the finished product are relinquished and all rights to payment or compensation are waived.

  • Do you consent?*

  • Adult Code of Conduct for People of God – Summer Camp

    Acknowledgment of Receipt of the Code of Conduct

     

    In accord with my role as a Camp personnel, and in witness to the Gospel of Jesus Christ, I will conduct myself with integrity, acting in a manner that is consistent with the discipline and teaching of the Scriptures, the People of God community and Sword of the Spirit communities.  I will guide my behavior by civil law and by the policies of the People of God Child Protection Policy by…

     

    1. Respecting the rights and God-given dignity of each person and advancing his or her welfare during the course of camp.
    2. Maintaining an open and trustworthy relationship when working with youth, free from inappropriate behavior that would put them at risk; including, but not limited to:


    ·       Using/possessing/being under the influence of drugs and or alcohol

    ·       Using foul language

    ·       Speaking in a manner that could be perceived as: harsh, threatening,                  intimidating, shaming, derogatory, demeaning, or humiliating

    ·       Hazing/bullying

    ·       Using corporal punishment

    ·       Engaging in sexual humor/conversations

    ·       Being nude

    ·       Possessing sexually oriented or morally inappropriate materials

    ·       Being overly attentive to a particular child

    ·       Giving special gifts

    ·       Establishing a 1:1 counseling relationship

    ·       Using cell phones/texting to communicate with minor.

    3. Providing an environment that is free from physical, psychological, written or verbal intimidation or harassment.

    4. Reporting to proper authorities my own ethical misconduct and the misconduct of others.
    5. Being responsible for my own spiritual, physical, mental and emotional health.
     

    I HAVE BEEN PRESENTED WITH THE POG CODE OF CONDUCT, I HAVE CAREFULLY READ, UNDERSTAND AND HEREBY COMMIT TO CONDUCTING MYSELF AS A VOLUNTEER IN ACCORD WITH THIS CODE. BEFORE CAMP, I WILL ALSO REVIEW THE PEOPLE OF GOD CHILD PROTECTION POLICY WHICH IS TO BE SENT OUT TO THE ADULT STAFF AHEAD OF CAMP.

  • I commit to abiding by this code of conduct and the POG Child Protection Policy?*

  • Junior Staff Policies for People of God – Summer Camp

    As a Staff Member for the People of God Summer Camp, I understand that it is my responsibility to fulfill my commitment to serve while relying upon God’s grace and empowerment. Meaningful and positive interaction with campers will be my main priority! Both fellow staff members and campers will be observing my conduct and therefore it is important to be a positive, Christian role model at all times.


    With this in mind, I realize that I am expected to:

    • Perform my assigned responsibilities to the best of my ability.
    • Support campers in their relationship with Jesus.
    • Seek and respect adult direction and supervision whenever necessary. (This is expected of everyone who is involved with camp!)
    • Model proper behavior/speech that is beneficial to the entire camp experience.
    • Encourage healthy interactions and discussions (no negative humor, swearing, gossip, etc.), thus providing opportunities for appropriate fun and fellowship.
    • Maintain a modest overall appearance (appropriate length shorts/skirt – at least fingertip length w/arms extended at my side, no exposure of spaghetti straps, midriff or boxer shorts, modest one-piece bathing suit, clothing/t-shirts should be free of wording that is flirtatious or ungodly and should not be ‘low-cut’!
    • Not use/purchase alcohol or tobacco products. They are not permitted on camp grounds!)
    • Be punctual for all scheduled assignments, arriving at a particular location prior to the requested time.
    • Adhere to the camp curfew -11pm.
    • Camp is an amazing opportunity to unplug from devices for the week. As such Juniors will not be allowed to use their devices for entertainment, music, or games at any time (whether free time or times of serving). If a device is brought to camp, it will be stored in the millennium building, and only be accessible in case of emergency or with prior stated permission from a director. 
    • At camp “flexibility is our middle name”. As such you may be asked to serve in a way that was not in your original job description. We expect that you will be quick to serve, remembering that everything we do at camp is in service to God and the campers

    ****By choosing to serve at camp I understand that the Summer Camp Director will assign a role for me that he considers to be most helpful to the camp mission. I agree to abide by all Summer Camp policies and guidelines. I also understand that choosing not to follow these policies and conduct guidelines during camp could result in my dismissal. I realize that it is the responsibility of the Summer Camp Directors to make this type of decision and that I would be responsible for supporting such a decision.

    I HAVE BEEN PRESENTED WITH THE POG JUNIOR STAFF POLICIES, I HAVE CAREFULLY READ, UNDERSTAND AND HEREBY COMMIT TO CONDUCTING MYSELF AS A VOLUNTEER IN ACCORD WITH THESE POLICIES

  • I commit to abiding by these Junior Staff Policies?*

  • SPECIFIC MEDICATION CONSENTS

     

    Over the Counter Medications: 

    The People of God Summer Camp stocks the following over the counter medications.  While we do not necessarily stock name brands, the brand names of medications are indicated in parentheses for easy recognition:

    Acetaminophen Jr. strength chewables and children’s strength liquid (Tylenol)
    Ibuprofen Jr. strength chewables and children’s strength liquid  (Motrin or Advil)
    Diphenhydramine Liquid and tablets (Benadryl)
    Children’s Mucous Relief Cough (Cough Suppressant and Expectorant)
    Hydrocortisone 1 % cream
    Diphenhydramine cream (Benadryl)
    Triple Antibiotic Cream with Lidocaine (Neosporin plus pain relief)
    Cough drops 
    Calamine lotion or generic equivalent

  • Over the Counter Medication Consent:  Do you give permission for your junior counselor named above to receive an age-appropriate dosage of over the counter medications for up to 24 hours while at camp?*

  • *** If an over the counter medication is administered for a full 24 hours, the nurses will communicate with parents/guardians before continuing to further  administer the medication

  • Epipen and/or Inhaler Consent* (if applicable):

  • Has the junior counselor been taught how to self-administer his or her rescue inhaler?*
  • Do you give consent for the above named junior counselor to carry and self-administer his or her rescue inhaler?*
  • Has the junior counselor been taught how to self-administer his or her epipen or epipen Jr.?*
  • Do you give consent for the above named junior counselor to carry and self-administer his or her own epipen or epipen Jr.?*

  • Adventure Trip Waiver, Consent and Release Form for Junior Counselors (if they are needed for service in this capacity)

     

    Intending to be legally bound hereby, I hereby freely, knowingly, and voluntarily consent to and give permission to my above named child, to participate in the adventure trip(canoe trip/hike/alternate activity dependent on the weather) held by the People of God summer camp and give my consent for my child to be transported by an adult staff member to and from this event.  I understand that in case of inclement weather that an optional activity will be chosen at the discretion of the People of God summer camp staff, and I give consent for my child to participate and to be transported to and from this alternate activity, if POG needs them to serve in this capacity.

     

    I fully recognize that my child’s participation during this canoe trip/hike /other activity can be dangerous, and hereby acknowledge that my consent to my child’s participation in any of these activities is voluntary and informed. I acknowledge that I have been advised of the risks to my child’s personal safety attendant to the canoe trip and other camp activities, and that, with a full and complete awareness of these risks, I consent to my child’s participation.  I acknowledge the staff has been fully, completely, and properly trained in the methods, practices, and techniques necessary and appropriate to any and all camp activities. I understand that the staff has taken every precaution to ensure the safety of my child.  I further acknowledge the staff has trained my child to properly participate in camp activities. Any use or nonuse of such methods, practices and techniques by my child shall, under no circumstances, result in claim against, or the imposition of any nature whatsoever, with respect to the People of God and its summer camp.

     

    As the parent off the above named child, I hereby fully waive, release and discharge the People of God, its agents, volunteers, employees, successors and assigns, from any and all rights, claims and actions, arising now and/or in the future, out of my child’s participation in the adventure trip and any and all other activities conducted by or under the auspices of the People of God.  I further agree to indemnify and hold harmless the People of God, from any claims arising out of any injury or harm my child may cause to the person or property of any and all individuals or groups during the course of their participation in the adventure trip.

     

  • Do you consent?

  • Permission for ride home (if not picked up from camp by parent/guardian):   

     

    If these plans change you need to reach out to us ASAP, we will not be able to release your child to anyone that is not a parent or legal guardian, unless we have express permission to do so. Email us at pogcamp@gmail.com with any changes 

  • Will a parent or legal guardian be picking up your junior counselor from camp?*

  • I give my permission for the People of God staff to release my child, into the care of
     
    * for transportation home from camp.

  • SIGN BELOW!

  • Date
     - -

  • Payment

    This year we are requesting that the junior staff pay $300. This is about what All Saints camp charges us for one person. For those planning to go on another regional mission/adventure trip, we are requesting that you pay half of this amount ($150.) Please only choose the third option if it truly applies, as the funds available for financial aid are limited.

  • We do not require our adult staff to pay for camp, as many are already making generous sacrifices and investments to serve camp. That being said you (or someone you know) may still feel called to support camp financially. You can do so at the following link (this should open a new tab, please make sure to come back to this document to submit your registration)

     https://www.paypal.com/donate/?hosted_button_id=DQD43ZBKAZTLC

  • Which applies most? *
  • prevnext( X )
        Junior Counselor
        $300.00
          
        Junior Counselor - participating in another Kairos mission/adventure trip
        $150.00
          
        Total
        $0.00
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        Choose from one of the PayPal options to make your payment.

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