Register for Camp Great Lakes

Cadet / Jr. Counselor Registration Information

All fields are required. This is the registration form to use if you will be a cadet or jr. counselor at the 2020 Cadet International Camporee.

Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Date of Birth*
MM slash DD slash YYYY
Email*
Club Number*
Club (CHURCH) Name*
Council*
T-Shirt Size*
Adult sizes
- S
- M
- L
- XL
- 2XL
- 3XL
Past Camporees Attended
Cadet or Junior Counselor
Register as
- Cadet
- Junior Counselor
Camporee Certificate*
- Provided for past Camporee
- Will be sent
Jr. Counselor Certification date*
MM slash DD slash YYYY
Have you ever been convicted of anything other than a minor traffic violation?*
- No
- Yes - please explain below
Conviction explanation
Counselor's Signature*
I certify that this registrant is an active member of our club and has successfully completed the Camporee Certification Course, including earning the required merit badges or guide trail.
Counselor Signature Date*
MM slash DD slash YYYY
Counselor's Name
Head Counselor's Signature*
Head Counselor Signature Date*
MM slash DD slash YYYY
Head Counselor's Name
Skills/Certification
First Aid Certified*
- Yes
- No
Assumption of Risk and Responsibility
- The registrant named on this registration form has my permission to attend the 2020 Cadet International Camporee in Michigan. I have read the requirements for camporee attendance and to the best of my knowledge the registrant meets these requirements. - I certify that the information on this form is true to the best of my knowledge. As legal parent or guardian, I understand that every effort will be made to contact me, but do hereby give permission for camporee medical staff or any licensed physician to render emergency medical care to my son in the event of a medical emergency. - I hereby release Dynamic Youth Ministries and the Calvinist Cadet Corps, its agents, employees, volunteers, and other parents from any liability for any claims of damages or injury to my child or my child's property. I understand that by signing this agreement, I absolve the Calvinist Cadet Corps, its agents, employees, volunteers, and other parents for any liability for any claims of damages or injury to my child and my child's property, for any injury or damages that may occur, including serious injury and death. I also covenant and agree not to sue Dynamic Youth Ministries and the Calvinist Cadet Corps, its agents, employees, volunteers, and other parents for any liability or any claims of damages or injury to my child and my child's property. I have read this release and covenant not to sue. I understand it and agree that I am bound by its provisions. - I give permission for photographs or videos of my child to be used by the Calvinist Cadet Corps for promotional purposes.
Parent/Guardian's Signature*
I have read the Cadet Camporee information above and agree to the terms of the assumption of risk and responsibility.
Parent/Guardian Signature Date
MM slash DD slash YYYY
Parent/Guardian Name*
Cadet or Jr. Counselor's Signature*
Cadet/Jr. Counselor Signature Date
MM slash DD slash YYYY
Family Camping / Sunday Visitors
Number of people camping at Mackinaw Mill Creek who need transportation to the Sunday worship service and lunch:
Not camping, but visiting for Sunday worship and lunch? How many reservations do you need?
Insurance Information
Insurance Company/Plan*
Insurance Policy Number*
Emergency Contact Information
Parent/Guardian Name*
First Last
Parent/Guardian Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Parent/Guardian Phone*
Parent/Guardian Mobile Phone
Parent/Guardian Email*
Relationship to Camper*
At camp or camping nearby? If so, where?
Emergency Contact #2 Name*
First Last
Emergency Contact #2 Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Emergency Contact #2 Phone*
Emergency Contact #2 Mobile Phone
Emergency Contact #2 Email*
Emergency Contact #2 Relationship to Camper*
At camp or camping nearby? If so, where?
Other persons to whom child may be released in an emergency
(Recommend listing adults traveling with the child)
Emergency Release Person 1 Name
Emergency Release Person 1 Relationship to Camper
Emergency Release Person 1 Phone
Emergency Release Person 1 at camp?
- Yes
- No
Health History
Special Medical Conditions
- Hay fever, asthma, or wheezing
- Eczema or frequent skin rashes
- Convulsions/Seizures
- Heart trouble
- Diabetes
- Frequent colds, sore throats, ear aches (four or more per year)
- Trouble with passing urine or bowel movements
- Shortness of breath
- Speech problems
- Dental problems
- High sensitivity to poison ivy
Other Medical Conditions*
Things to be watched for, such as fainting, sleepwalking, history of emotional or behavioral disturbance, etc. Please explain.
Special Dietary Requirements*
Dietary needs or restrictions such as gluten, lactose, or nut intolerance, diabetic, etc. Please explain.
Allergic Reactions
Allergies to medications, food, or environmental factors. NOTE: Bring your own EpiPen(s) if required.
Allergy Reaction Treatment EpiPen Req'd
Date of Tetanus Immunization*
REQUIRED - date must be after 7/22/2010
MM slash DD slash YYYY
Has camper received standard childhood vaccines and immunizations?*
- Yes
- No
Please explain vaccine/immunization
Medications
Please list all. Medications must be in original containers.
Medication Dosage Frequency Currently used?
Activity Restrictions*
because of any illness, injury, or physical disability?
- No
- Yes
Degree of Restriction
Please explain the degree of your restriction
Operations or Injuries
Other
List anything else you think should be passed on to the boy's cadre counselor and camporee staff.

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FINANCIAL ASSISTANCE

Cornel Rylaarsdam Memorial Fund

Some families would like to send their son to an international camporee, but they simply don’t have the financial resources to make it work. The CRMF is available to help pay part or all of the registration fees for individuals who need help. The request is reviewed by the Steering Committee of the International Camporee.

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CONTRIBUTE

Give to the Fund

Your contribution will give boys the opportunity to participate in this great adventure.

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Allergy	Reaction	Treatment	EpiPen Req'd

Medication	Dosage	Frequency	Currently used?

Register for Camp Great Lakes

Cadet / Jr. Counselor Registration Information

Cadet or Junior Counselor

Skills/Certification

Assumption of Risk and Responsibility

Family Camping / Sunday Visitors

Insurance Information

Emergency Contact Information

Other persons to whom child may be released in an emergency

Health History

FINANCIAL ASSISTANCE

Cornel Rylaarsdam Memorial Fund

CONTRIBUTE

Give to the Fund