CAMP GEMS APPLICATION Name ______________________________________________________ Age________________________ Address:____________________________________________________ Birthdate:______/______/______ City:________________________________________________State:________Zip Code:______________ Campers preferred first name (to be used on name tag):__________________________________________ Day Phone: (_______)______________________ Night Phone: (_______)_________________________ Email address_____________________________ Parent Cell Phone (________ ) ____________________ School Name:_____________________________ Grade in fall 2012_______________________________ Please list extracurricular school, community and church activities in which you participated this year (e.g. student council, music groups, patrol, etc.).________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ What do you like to do in your spare time (hobbies, etc.)?_________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ Shirt size (Adult) :
S
M
L
XL
2X
Roommate Request Roommate requests are honored whenever possible. However, BOTH friends must request each other. If you request to room with a friend, but your friend does not request you, you WILL NOT be placed together, and it will not be possible to switch rooms when you arrive. If possible, I would like to room with (friend’s name):____________________________________ .
APPLICATION DEADLINE: June 1, 2012 CAMP GEMS FEE:
$295, which includes room, board and educational materials.
CHECKS PAYABLE TO:
Ohio Northern University Camp GEMS
SEND APPLICATIONS AND CHECKS TO:
Laurie Laird Ohio Northern University College of Engineering 525 South Main Street Ada, OH 45810
WHAT TO BRING
INSURANCE
Be prepared to handle all kinds of weather: warm/ cool, rain/shine. Old clothes that are comfortable, durable and washable are recommended. Remember, the camp runs for four days.
Campers are expected to provide their own
Soap, comb, and/or brush, tooth- brush, toothpaste, deodorant, etc. Long jeans or slacks Shorts Shirts or blouses Sweater or sweatshirt and jacket Socks (one pair per day) Pajamas Underwear Swimsuit and beach towel Rain gear Two pairs of sturdy shoes (one pair suitable for use in gym) Plastic garbage bag for dirty clothes One dress-up outfit for dinner Sunscreen and bug repellent Alarm clock Towels and washcloths for shower Sleeping bag or bedsheets and blanket Pillow
Optional Equipment Backpack Camera and film Shower clogs Hair dryer Tennis racket and balls Roller blades/rollerskates Small fan Flashlight with new batteries
medical insurance. Ohio Northern University does not assume direct responsibility for the health care of those using the facilities of the University for summer programs. A registered nurse is on call 24 hours per day. In the event of injury or illness, campers are transported to Lima Memorial Hospital or St. Rita’s Medical Center in Lima. The camp is not responsible for lost or stolen items. Campers are provided keys to rooms and are encouraged to use them.
CAMP FEES The camp fee is $295 and includes room, board and educational materials. Transportation to and from the camp is not included or provided.
Make checks payable to: Ohio Northern University Camp GEMS
Payment in full is required with the camp application. The camp maximum is 72 girls. Applications are accepted on a first-come basis. Fees are returned if the camp is full. No refunds after July 1, 2012.