2012 Camp Chippewa Summer Camp Brochure

If you really like to

HAVE FUNthen you’re gonna love

Summer Camp

Camp Chippewa

2012

Camp Chippewa SCholarShip appliCation - 2012

To be completed by your local Pastor and mailed to: Summer Camp Scholarship & Registration Camp Chippewa 2577 Idaho Rd., Ottawa, KS 66067

The Kansas East Conference camping program desires that youth be able to attend camp, regardless of their ability to pay. Therefore, limited funds are available to assist persons in need to attend Camp Chippewa. To apply for funds the following guidelines need to be followed:

1) Your Pastor should complete this form. By doing so you are certifying that there is financial need greater than can be provided by the family and the church.

2) The scholarship request must be sent to the Camp Chippewa address in order to be processed.

3) To help build ownership, families are expected to provide at least a token amount of funds.

4) There is a limit of one Camp Chippewa Scholarship per individual per summer for financial assistance.

5) To assist as many campers as possible, Scholarships will be granted in an amount equal to the local church’s financial assistance. With a maximum of the following per registration:

$75.00 for 5 day camps$25.00 for 3 day, 4 day, and KAP camps$15.00 for Day Camps

**If campers move to a shorter week of camp the scholarship amount will be adjusted. **Your pastor should contact the Director of Camping Ministries directly regarding special circumstances for greater support

CAMPER’S NAME: _______________________________________ GRADE ________ AG _______ SEX _____

FULL ADDRESS: _________________________________________ PHONE: ( ______ ) __________________

Camp registered for: ______________________________ Camp # ___________ Camp Dates: __________

With whom does applicant reside? Name(s): ____________________________________________________

Clergy, please attach a letter explaining the circumstances for the scholarship request. Please also list any areas of special concerns or problems that the camp should be made aware. (Please be specific, information will be kept confidential)

I certify that there is sufficient need for requesting Camp Scholarship funds

Signature of Clergy: _______________________________________Date: ___________________________

Church: _____________________________________________ District: _________ Phone: ____________

Church Address: _________________________________________________________________________ The cost of camp* will be covered as follows:

The Families portion of camp fees: $ _________________

Amount coming from the Local Church: $ _________________

Amount coming from other Organizations: $ _________________

Amount request from Chippewa Scholarship: $ _________________

*Scholarships may not be used as the $50.00 deposit fee for campers to register.

1/12rev

offers year-

round facility use for all groups and

organizations. Whether you are feeling

the need to get back to the basics

of life, or to get a fresh start in your

spiritual being, what better place, than

in our Master’s Creation?

There’s a feeling of wholeness when

you experience a campfire, under a

blanket of starlight, and a spiritually

renewed feeling falls over you with

the crisp autumn air. You can hear the

silence of God’s word in the trees, as

you venture to a place where you are

thankful of having this day to rejoice in

the simple, natural setting found here

at Camp Chippewa.

Camp Chippewa

www.CampChippewa.org

GraDeS K-3KiDS & parentSWhether it’s your first time to camp or you want to share your experience of God’s creation. Bring along an adult, parent, guardian, or grandparent, aunt, or uncle!! You will have a fun filled, faith-based taste of camp with Worship, Bible study, devotions, lead rides, hiking, archery, swimming, wagon ride, and crafts all scheduled within this overnight camping experience. Cost: $115.00 ($100.00)*

1210 GeneralDate: June 15-16 Grade: K-3 Max: 25 kids/25 adults

1225 GeneralDate: July 20-21 Grade: K-3 Max: 25 kids/25 adults

GraDeS 3-5Faith & FUnFaith & Fun Camps provide campers the opportunity to grow in their faith through the word of God and experience a variety of camp activities. Horseback riding, archery, swimming, low ropes, boating, hiking, crafts, wagon ride, cookout, fishing, and games. Three-day camps are available to accomodate busy schedules, however with the limited time activities will vary. All camps include Worship, Bible Study, and daily devotions. Cost: Three-day $150.00 ($125.00), Five-day $275.00 ($250.00)

1212 General Date: June 18-23 Grade: 3-5 Max: 20 boys/20 girls

1222 GeneralDate: July 9-14 Grade: 3-5 Max: 20 boys/20 girls

mini Faith & FUn

1215 GeneralDate: June 25-27 Grade: 3-5 Max: 10 boys/10 girls


livinG waterSExperience the living water of Jesus Christ through water activities at Camp Chippewa. Paddle boats, swimming, water games, and learning about God are just a few of the activities you will experience during your week at camp. A day trip to a local waterpark is planned for Thursday. No horseback riding. Cost: $350.00 ($325.00)

1228 Water Date: July 16-21 Grade: 3-5 Max: 24 kids/24 adults

GoSpel & GameSGospel and Games Camps feature lesson time devoted to learning to use the Bible. First time campers to this particular camp will receive their very own Bible. Camp activities include; Worship, Bible study, daily devotion, horseback riding, cookout, fishing, pedal boats, and swimming.Cost: $150.00 ($125.00)

1226 Bible ExplorationDate: July 16-18 Grade: 3-5 Max: 10 boys/10 girls

StarS & GalaxyA fun camping experience with an educational twist! Under the dark skies of Kansas, campers will learn about this universe our God has placed us in. Our young astronomers will participate in star gazing, space art, and so much more. Campers will also participate in traditional camp activities throughout the week.Cost: $275.00 ($250.00)

1207 AstronomyDate: June 11-16 Grade: 3-5 Max: 10 boys/10 girls

2012 Summer Camp Adventures!

*Prices shown in parentheses is the discounted rate for early registration. Camp Chippewa is a ministry of the Kansas East Conference of The United Methodist Church

Camp Chippewa

natUral FaithA fun camping experience with an educational twist! Learn about the trees, animals, and skies of God’s creation. Campers will also participate in traditional camp activities throughout the week, Bible study, and daily worship.Cost: $275.00 ($250.00)

1202 Nature CampDate: June 4-9 Grade: 3-5 Max: 10 boys/10 girls

GraDeS 3-8ConFerenCe Faith & FUnA fun and new way to spend Annual Conference this year. This camp is designed specifically for children of pastors and other leaders of the church. Check-In will occur at Annual Conference. Campers will be bussed to Camp Chippewa for the remainder of Annual Conference and brought back on Saturday for pick up.Cost: $125.00 ($150.00)

1201 Annual ConferenceDate: June 6-9 Grade: 3-8 Max: 10 boys/10 girls

GraDeS 5-8BootS n’ BiBleThe Boots N’ Bible programs are designed to give opportunities in riding and handling a horse in your camp community. Campers will share in spiritual growth through daily Bible study, Worship, and many other camp activities.Cost: $350.00 ($325.00)

Beginners: All riders are welcome regardless of skill or experience. This camp is designed with the beginner rider in mind, to give campers an opportunity to learn to ride and handle horses. Our camp wrangler staff will work individually with riders learning basic horsemanship skills. A majority of the time will be spent exploring 640 acres of scenic trails through the Chippewa Hills.

1205 Beginners 1 Date: June 4-9 Grade: 5-8 Max: 8 boys/8 girls

1229 Beginners 2Date: July 16-21 Grade: 5-8 Max: 8 boys/8 girls

1232 Beginners 3Date: July 23-28 Grade: 5-8 Max: 8 boys/8 girls

Intermediate: Needs to have 1 year Boots and Bible ex-perience or approval through camp office. This camp is designed for campers that have a basic understanding of horsemanship and are interested in furthering their understanding of the horse. Each camper will be assigned a horse for the week. Campers will groom and saddle their horse in the morning and unsaddle at night. Campers will also get the chance to assist in feed-ing and basic horse care. In addition to trail riding, area work and a half-day trail ride with a cookout a Briscoe Lake will be experienced

1211 Intermediate 1Date: June 11-16 Grade: 5-8 Max: 8 boys/8 girls

1224 Intermediate 2Date: July 9-14 Grade: 5-8 Max: 8 boys/8 girls

Advanced: Needs to have 2 years Boots and Bible experi-ence or approval through the camp office. In the Advanced camp riders will be assigned a horse for the week and will be involved in every part of the horses day-to-day activities. Campers will experience trail rides and be introduced to more advanced horsemanship topics. The camp wrangler staff will lead arena exercises in preparation for arena games on the last day of camp. Campers will go on an overnight trail ride to Briscoe Lake, where they will cook out and enjoy a night under the stars.

1214 AdvancedDate: June 18-23 Grade: 5-8 Max: 8 boys/8 girls

GraDeS 6-8Faith & FUnFaith & Fun Camps provide campers the opportunity to grow in their faith through the word of God and experience a variety of camp activities. Horseback riding, archery, swimming, low ropes, boating, hiking, crafts, wagon ride, cookout, fishing, and games. Camps will include Worship, Bible Study, and daily devotions. Cost: Five-day $275.00 ($250.00)


1223 General Date: July 9-14 Grade: 6-8 Max: 20 boys/20 girls

More Great Adventures >

Help us conserve camping resources. Please recycle this catalog!

GraDeS 6-8 (Cont.)mini aDventUre CampThree-day canoeing and camping adventure. The relaxed schedule encourages great fellowship and fun. Includes time set aside to learn about God in a beautiful and natural setting. Most activities take place off site and involve sleeping in tents. Campers should be prepared to participate in these high energy activities and be physically able to keep up with the group.Cost: $150.00 ($125.00)

1217 Canoeing Date: June 25-27 Max: 5 boys/5girls

leaDerShip on the ropeSWork together in team-building activities throughout the week learning communication skills, patience, innovative thinking, problem-solving techniques, and focusing on spiritual growth as the foundation of leadership formation. Finishes with an offsite high ropes challenge course at the end of the week.

Cost: $300.00 ($275.00)

1206 RopesDate: June 11-16 Grade: 6-8 Max: 10 boys/10 girlslivinG waterSExperience the living water of Jesus Christ through water activities at Camp Chippewa. Canoeing, swimming, water games, and Bible lessons are just a few of the activities you will enjoy throughout the week. A day trip to a local waterpark is planned for Thursday. No horseback riding. Cost: $350.00 ($325.00)

1230 WaterDate: July 23-28 Grade: 6-8 Max: 20 boys/20 girls

FoCUS on FaithDiscover the beauty of God’s creation through the lenses of your camera as you hone your photography skills in addition to participating in traditional camp activities and exploring God’s word. We’ll travel to a local art gallery for the day and have the opportunity to display your pictures at the end of the week. Campers should bring along their own digital cameras.

Cost: $300.00 ($275.00)

1204 PhotographyDate: June 4-9 Grade: 6-8 Max: 10 boys/10 girls

hooK, line & JeSUSSearch by land and by boat for the big one! Learn new fishing techniques and share your best fishing stories with old friends and new. Explore Camp Chippewa for its best fishing spots and take a day trip to the local State Lake for a change of pace. Dig, not just for worms, but also into the bible searching through the parables of Jesus. We will end the week with a Fish Fry of our week’s catch.Cost: $300.00 ($275.00)

1203 FishingDate: June 4-9 Grade: 6-8 Max: 10 boys/10 girls

1225 FishingDate: July 16-21 Grade: 6-8 Max: 10 boys/10 girls

GraDeS 9-12mini aDventUre CampDo you like treasure hunts? Geocaching is one of the fastest growing outdoor activities. It is a hi-tech scavenger hunt that utilizes a handheld GPS unit, a good set of eyes and a bit of hiking around. This three day camping adventure sets aside time for Bible study and the relaxed schedule encourages great fellowship and fun. Most activities take place off site and involve sleeping in tents. Campers should be prepared to participate in these high energy activities and be physically able to keep up with the group.Cost: $150.00 ($125.00)

1218 Geo CachingDate: June 28-30 Grade: 9-12 Max: 5 boys/5 girls

livinG waterSExperience the living water of Jesus Christ through water activities at Camp Chippewa. Canoeing, swimming, water games, and learning about God are just a few of the activities you will enjoy throughout the week. A day trip to Oceans of Fun is planned for Thursday. No horseback riding. Cost: $350.00 ($325.00)

1231 WaterDate: July 23-28 Grade: 9-12 Max: 20 boys/20 girls

*Prices shown in parentheses is the discounted rate for early registration. Camp Chippewa is a ministry of the Kansas East Conference of The United Methodist Church

2012 Summer Camp Adventures!Camp Chippewa

BootS n’ BiBleView God’s Creation on horseback! Needs to have 1 year Boots and Bible experience or approval through camp office. In the Sr. High camp riders will be assigned a horse for the week and will be involved in every part of the horses day-to-day activities. Campers will experience trail rides and be introduced to more advanced horsemanship topics. The camp wrangler staff will lead arena exercises in preparation for arena games on the last day of camp. The traditional ranch relay will be held during this week and campers will get a chance to learn how to through a rope. Campers will go on an overnight trail ride to Briscoe Lake, where they will cook out and enjoy a night under the stars. Cost: $350.00 ($325.00)

1221 High SchoolDate: June 25-30 Grade: 9-12 Max: 8 boys/8 girls

SpeCial neeDSnew aDventUreAn adventure in God’s great outdoors for high functioning developmentally challenged campers ages 18 and older. A challenging opportunity to come together and experience this three-day camp filled with Worship, daily Bible study, devotions, swimming, fishing, archery, wagon ride, cookout, crafts, time with the horses,and hiking to and from activities. Our Volunteer Staff provide supervision & spiritual fellowship.Cost: $150.00 ($125.00) Must be pre-approved.

1208 Special NeedsDate: June 11-13 Age: over 18 Max: 10M/10W

1209 Special NeedsDate: June 25-27 Age: over 18 Max: 10M/10W

new aDventUre Day CampCost: $50.00 Must be pre-approved.

1219 Special NeedsDate: June 14 Age: over 18 Max: 10M/10W

1220 Special NeedsDate: June 28 Age: over 18 Max: 10M/10W

ConFerenCe CoUnCil on yoUth miniStrieS eventS

marCh 3-4: MID-HIGH/CONFIRMATION RETREATOvernight event at Camp Chippewa designed for mid-high students and for students in confirmation classes. In 2011, we used the new Credo confirmation curriculum and concentrated on making stoles that detailed our journey in Christianity. Estimated cost: $40.

JUne 17-23; JUly 15-21: INSTITUTEEach held at Baker University in Baldwin. Online registration will be open February 1st. Week long retreat for high school students to experience their faith walk in a personal way. Small groups are formed to work out disciplines taught during the week. Nightly worship and late night activities. CCYM scholarship applications available at www.kansaseast.orgRegistration: $350 ($325)

JUly 30:WORLDS OF FUN/OCEANS OF FUN DAYPass for both parks and lunch are included in the cost of the ticket. Oceans of Fun is open until 6 p.m. and Worlds of Fun is open until 10 p.m. Open to junior and senior high youth. Cost: $50.00

oCtoBer 6: CHRISTIANS IN ACTION MISSION EVENT (C.I.A.)Held at Chanute First UMC. In 2011, we worked in Topeka at Harvesters, Amistad de Fe, Forest Park Campground and Retreat Center, Asbury Mount Olive UMC, and Ichtus Washburn Campus Ministry. We worship and work in the community that we hold the event in. Great taster event for mission!Cost estimate: $18( includes t-shirt, offering to Youth Service Fund, insurance and lunch)

novemBer 16: BISHOP’S ROUND-UP FOR HUNGER LOCK-INHeld at Lawrence First West Campus. We prepare for our morning of service by fellowshipping the night before with worship, study, games and pizza. On November 17, 2012, we travel to the Douglas County Fairgrounds for the round-up. Junior High and Senior High youth welcome! Cost: $5.00

Help us conserve camping resources. Please recycle this catalog!

(Be sure to copy both sides of this form when making additional copies.)

Camper History: Please check/circle all that apply:oChronic infection of throatoChronic infection of earsoChronic infection of sinusoChronic infection of lungsoChronic infection of urinary tractoFaintingoNose bleedsoCrampsoHeart conditionoHigh blood pressure; is it controlled? Y N oDiabetes; is it controlled? Y N oSeizure; is it controlled? Y N oEpilepsy; is it controlled? Y N oSleep WalkingoAsthma or other breathing conditionsoChronic digestive or gastric complaintsoBed wetting or bladder controloAnxietyoHyperactivityoADD or ADHDoViolent or aggressive behaviors

Please explain: ____________________________________

_______________________________________________

_______________________________________________

_______________________________________________

_______________________________________________

Please circle “Y”(yes) or “N”(no) for each of the following:Y N Camper can walk up and down stairs easilyY N Camper has been recently exposed to a contagious disease If yes please identify:Y N Camper has tubes in the ear. If yes which ear(s)?Y N Camper has a skin disease. If yes please identify:Y N Camper has experienced unusual stress or trauma. If yes please explain:Y N Is there a physical, mental, psychological, spiritual or social

condition requiring restricted activities or special assistance?

If yes to any, please explain: __________________________________

_________________________________________________

Allergies and Dietary needs:Does camper require a diabetic diet? Y N Please list all allergies including those to food, medications and environment.

_______________________________________________________

_______________________________________________________

Immunizations:Please give the date of the most recent (month/year if possible.)__/__ Tdap (Tetanus, Diphtheria, Pertussis)__/__ Influenza__/__ HPV (Human Papillomavirus)

__/__ Hepatitis A__/__ MCV4 (Meningococcal)__/__ Hepatitis B__/__ PPV (Pneumococcal)__/__ IPV (Poliovirus)__/__ Varicella__/__ MMR

All campers, regardless of health, must MAIL this completed and signed form WITH THE REGISTRATION FORM. The camper will not be admitted to camp or travel without it. Confidentiality will be honored. Be sure to copy both sides of this form when making additional copies. For further explanation of answers, use additional paper as needed and attach.Please list all medications on the opposite side of this form.

2012 UniteD methoDiSt health hiStory & treatment aUthoriZation

Camper’s Name _________________________________

Camp # _____________ Birthdate ____ / _____ / ____

Social Security # _________ – _______ – ____________

Date of camper’s last tetanus shot ____ / _____ / _____

Name (print) ____________________________________

Date____/_____/____

Relationship to Camper __________________________ (“parent”, “legal guardian” or “self”)

Family Medical Insurance Company _________________

_______________________________________________

Name of Insured ________________________________

Policy # __________________ Group # _____________

Physician _______________________________________

Phone (________) ______________________________


I understand that camp staff need to know pertinent information about the camper’s mental and physical health. Therefore, I have disclosed all information that could jeopardize the camper’s health and safety or the safety of others. Failure to disclose information could require my child to be sent home from camp. I give permission to the camp to provide routine health care, administer prescribed and over-the-counter medications, seek emergency medical treatment including ordering x-rays and routine tests, and arrange necessary related transportation. I agree to the release of any records necessary for insurance purposes. In the event I cannot be reached (or cannot respond if an adult camper) in case of an emergency, I give permission to the physician(s) selected by the camp staff to secure and administer proper treatment, including hospitalization, for the above-named person and to release information regarding said medical treatment to camp staff. Unless otherwise indicated, I release all rights to photos taken at camp solely for purposes of promotion by the Kansas East Annual Conference.

Signature _____________________________________________(parent, legal guardian or adult camper)


NOTICE TO PARENTS/LEGAL GUARDIANS:When any medication is to be taken at camp, this form must be completed. Medicines must come to camp in the original container from the pharmacy and show the camper’s name, physician/dentist’s name, prescription number, name of the medication and dosage. Non-prescription medications must also come to camp in their original containers. Thank you.

Name of camper: _______________________________________________________________________

Physician or Dentist: _____________________________________________________________________

Prescription drugs to be taken (use additional paper as needed and attach to form):

1. Medication name: _______________________________ Prescription #: ___________________________

Time(s) to be given: __________________________________ Dosage: ____________________________

How long has camper taken this medication at this dosage? _________________________________________

2. Medication name: _______________________________ Prescription #: ____________________________



3. Medication name: _______________________________ Prescription #: ____________________________



Non-prescription drugs to be taken (use additional paper as needed and attach to form):

Drug: _________________________ Time(s) to be given: _______________ Dosage: __________________



REASON(S) FOR MEDICATION(S): __________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

I hereby request that (name of camper) __________________________________________________________ receive the above medication(s) at camp as noted and that the nurse or another adult camp leader administer the medication. I understand it is my responsibility to furnish this medication and proper instructions for administering the same. I further understand and agree that on behalf of myself and the above named person, I do hereby waive and release any action, cause of action or claim of liability for any loss, damages, accident or injury of any kind against the Kansas East Annual Conference and against any nurse or adult camp leader arising from the administration of medication, including, but not limited, to any claim that medication was negligently administered, and I agree to indemnify, protect and hold harmless such persons and the Kansas East Annual Conference from any and all such claims.

Name (print) ____________________________________________________________________________ (parent, legal guardian or adult camper)

Signature ______________________________________________________________________________ (parent, legal guardian or adult camper)

Relationship to Camper: ______________________________________ Date: _______ / _______ / ______ (“parent”, “legal guardian”, “self”)

2012 reQUeSt to aDminiSter meDiCation

REGISTRATION INSTRUCTIONS:• Fill out the forms completely with accurate information. Incomplete information will slow down the

registration process and may result in a camper not getting his/her first-choice camp.

• School grades listed refer to the grade for the fall of 2012. Please select camps for the appropriate grade level.

• Registration form MUST be signed by the camper and the parent or legal guardian for minor children and other applicable cases. Health form must be signed by the parent or legal guardian.

• After completing the registration and health forms, make a copy of both sides for future reference.

• Registrations will not be taken over the phone.

Register early! Camp prices in parentheses will be used for all registrations postmarked before April 15.

CANCELLED REGISTRATIONS & REQUESTS TO CHANGE CAMPS:All requests to change camps or to cancel registration are subject to an administrative fee of $20.

• Full refund minus administrative fee: 15 days or more before camp’s start date.

• 50% refund minus administrative fee: 14 days or less before camp’s start date.

• No refund for no-shows. Exceptions for illness or injury or for a death in the family only.

PAYMENT INSTRUCTIONS:• You may pay for your camp online, or send payment, along with camp forms, to:

• Send registrations and payments to: KEC–Camp Chippewa, PO Box 4187, Topeka, KS 66604. Make checks payable to Camp Chippewa. Send faxed credit card-paid registrations to 785-242-8525.

• For CCYM EVENTS, send registrations and payments to: Kansas East Conference c/o Brenda Davids, PO Box 4187, Topeka, KS 66604. Make checks payable to Kansas East Conference. Send faxed credit card-paid registrations to 785-272-9135.

HELPFUL REMINDERS:• Register early! Some camps fill up quickly. Registering online is even faster: www.campchippewa.org

• Campers/parents are responsible for transportation to and from camp.

• Maps and directions to Camp Chippewa are located on the camp website.

• A confirmation letter and participation agreement will be emailed after the registration is processed. Please provide an active email address to help this happen. The letter includes information about what to bring to camp as well as arrival and departure times.

NEED TO KNOW MORE?More information, downloadable forms, and camp updates can be found online at

Camp Chippewa: www.campchippewa.org

Conference: www.kansaseast.org

2012 Camp reGiStration inStrUCtionS & poliCieS


2012 UniteD methoDiSt Camp reGiStration FormINFORMATION MUST BE TYPED OR PRINTED LEGIBLY IN DARK BLUE OR BLACK INK.IMPORTANT: Before completing this form, please read the instructions and policies.

reGiSter onlineIf you have a computer and internet connection, save the paperwork and register for camp online:

CHIPPEWA:www.campchippewa.org

CAMP CHOICE

1st Choice: CAMP#:_________________ Price: $ ______ CAMP NAME: _______________

2nd Choice: CAMP#: ________________ Price: $ ______ CAMP NAME: _______________

Friend’s name, if you’re trying to go to the same camp together: ___________________________

CAMPER’S INFORMATION

First Name: ___________________ Last Name: _____________________________________

Mailing Address: ___________________________ City: _____________________________

State: ____________________________________ Zip: _____________________________

Home Phone: ______________________ E-mail Address: _____________________________

Birth date: ______________________ Attends church at: _____________________________

Male: _____Female: ______ School Grade for Fall 2012: _____________________________

Camper lives with (circle one): Both Parents | Mother | Father | Other:_____________________ (Name/Relationship to Camper)

I agree to participate fully in the activities for which I have registered, obeying safety regulations

and directions of all camping staff: __________________________________ Date: __________________________ (camper’s signature — MUST BE SIGNED)

Mother or Legal Guardian’s Name: ________________________ Relationship to camper: _________________

Mailing Address: ___________________________ City: ______________________State: _____ Zip: __________

Telephone | Home: ( ______ ) ____________ Work: ( ______ ) _______________ Cell: (_______ ) _____________

Father or Legal Guardian’s Name: _________________________ Relationship to camper: _________________



Caseworker or Emergency Contact: _______________________ Relationship to camper: _________________



I give permission for ________________________________________to attend camp and participate in its activities. (print Camper’s first and last name)

Signature: _____________________________________________________________ Date: _________________ (parent’s or legal guardian’s signature — MUST BE SIGNED)

PAYMENT INFORMATION

Circle type of card: VISA MasterCard Account#: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

Exp. Date: _____ / _____ Security Code: ______ Name of Card Holder: ____________________________________

Authorized Signature: ___________________________________________________________________________

MAIL TO:

CHIPPEWA: KEC–Camp Chippewa, PO Box 4187, Topeka, KS 66604

CCYM: Kansas East Conference c/o Brenda Davids, PO Box 4187, Topeka, KS 66604

2012 Camp reGiStration inStrUCtionS & poliCieS

Kansas East ConferenceUnited Methodist ChurchP.O. Box 4187Topeka, KS 666o4-0187

Return Service Requested

Nonprofit OrganizationU.S. Postage

PAIDTopeka, KansasPermit No. 247

Camp Chippewa

2012

If you have a computer and internet connection, save the paperwork and register online:

www.campchippewa.org

REGISTER

ONLINE for Summer Camp!

2012 Camp Chippewa Summer Camp Brochure

Documents

camp chippewa address

camp dates

cost of camp

shorter week of camp

scholarship request

families portion of

day camps

church address