Family Camp Registration
Please complete the form below for each person in your cabin AND submit your registration fee via our website online store. Registrations will only be held once the registration fee is received. Submit payment for individual campers in your party NO LATER THAN APRIL 30 via our website online store. Thank you, and we look forward to hosting your family at Camp Koinonia! contact@campkoinoniany.org
Which week? *
Family Name (For your cabin door. If a last name is shared, please include a first name as well.) *
Your answer
Full first name of this camper *
Your answer
Last name of this camper *
Your answer
What first name should we put on the camper's name tag? (full first name or nickname) *
Your answer
Camper's payment level *
Is this camper up to date with immunizations? *
Camper's Date of Birth (if under 21)
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Camper's Grade in September
Does this camper have dietary restrictions?
Does this camper carry emergency medicine?
Does this camper have other special needs requiring accommodation such as handicap accessibility, activity restrictions, special requests, etc.?
Your answer
(All of the remaining questions/information on this form need to be completed for family members 18 and over only. For campers 17 and under, scroll to the bottom and click "submit".) Family Camp Retreat Agreement: All participants of the Family Camp Retreat are guests of Camp Koinonia and are required to follow the following Camp policies and safety regulations: Camp Koinonia Family Camp Pool Policy: There is no lifeguard at Camp Koinonia. In order to maintain the safety of all of our campers, the following pool policy is in place. Swimming is allowed only when announced by the Program Director. No one is to be in the pool area at any other time. When the pool is open, there must be two adults on the pool deck at all times. One of these adults will be provided by the Camp. The other adult must be a parent. Any child who is swimming must have an adult (parent or designated adult) present in the pool area. Teen staff cannot be responsible for children in the pool area. While the pool is open, the designated Camp adult will have a phone and whistle with him/her at all times. If told to exit the pool, all swimmers must do so immediately.
Family Camp Alcohol Storage and Consumption Policy: In the spirit of Family Camp, we expect drinking of alcohol to be done responsibly and in moderation. Hard liquor (such as whiskey, vodka, etc.), kegs or mass quantities of alcohol are not permitted on Camp property. Beer and wine, including wine coolers, are allowed to be stored by campers at the Camp Store only and consumed only in the evening when the store is “open” during regular store hours, as determined by the Spiritual Directors and Camp Manager. The store must close by midnight. Drinking of any alcoholic beverages is not permitted at other times or in other areas of the Camp. At the discretion of the Spiritual Directors in consultation with the Camp Manager, anyone found to be in violation of this policy may be asked to leave, without refunding of any fees paid.
Treatment Authorization and Permission: I authorize Camp Koinonia staff to administer immediate and emergency medical treatment, including (1) transporting you or your child to a hospital emergency room or (2) calling the local rescue squad or ambulance. I authorize program staff to secure any licensed hospital, physician and/or medical personnel any treatment deemed necessary for the participant’s immediate care.
Photo & Video Release: I hereby give permission for images and/or videos of myself and my family members captured during Family Camp to be used by Camp Koinonia for the sole purpose of promotional material and publications, including but not limited to, the Family Camp website and related social media accounts.
Camp Koinonia Directory: I hereby give permission for my name, mailing address, email and phone to be included in the Camp Koinonia Directory.
Street Address
Your answer
Street Address 2
Your answer
City
Your answer
State
Your answer
Zip+4
Your answer
Phone (with area code)
Your answer
Alternate Phone (with area code)
Your answer
Email
Your answer
Home Parish
Your answer
What year did this family first come to Camp Koinonia?
Your answer
How did this family first hear about Camp Koinonia?
Your answer
Emergency Contact Name (Be sure to give your people the Camp phone number to reach you in an emergency as there is no cell phone or Internet reception at Camp. It's on our website, but for your convenience, it is: 585-554-3092. )
Your answer
Emergency Contact Phone Number (with area code)
Your answer
Would you like to donate a "Camper Scholarship" to a Teen Staff or Family Camper who needs it?
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