Alcohol, drugs, tobacco, bad language and inappropriate pictures/books/magazines are prohibited at all times.

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1 CAMP 4.5 RULES Alcohol, drugs, tobacco, bad language and inappropriate pictures/books/magazines are prohibited at all times. Each camper is under the leadership of, and subject to the directions given by the group leaders/church staff and camp staff at all times during the trip. Respect for authority is expected at all times. Campers will not damage anyone else s property. Property damage, either intentionally or unintentionally, will be paid for by the person or persons responsible. All campers are expected to follow the dress code. Campers not complying will be asked to change clothes. If at any time during camp a leader asks a camper to change clothes, they should do so immediately without question or complaint. At no time will a camper leave the campgrounds without an adult. The camper will attend all scheduled sessions. Campers will not leave their cabins after lights out. Boys are not allowed in the girls cabins at any time, and girls are not allowed in the boys cabins at any time. Cell phones, ipods, screen devices of any kind, etc., will be allowed only on the trip to and from Camp Como. These items cannot be used at any time during the week of camp and will be confiscated if used. It s best to leave them at home. Any confiscated items will be returned on Friday. Calls home are not permitted. If campers are unable to abide by the rules stated above, they will be sent home immediately at their parents/guardian s expense. This consequence is completely at our discretion and may be deemed necessary due to behavioral misconduct, violation of the dress code or leaving the cabin after lights out, etc. My signature certifies that I am willing to abide by the rules and regulations outlined in the Camp 4.5 Rules. My parents and I understand that breaking any of the above rules and regulations will result in me being sent home immediately at the expense of my family. Tear/cut off section below and turn in with signed doctor s forms Camper Signature Date Parent Signature Date

2 DO NOT BRING SNACKS FOR YOUR CABIN... If you have any questions, please do not hesitate to contact your Children s Staff. Snack Shack/General Store $$ (you will be able to purchase snacks, Gatorade, Propel and Como souvenirs) Prescription Meds/Supplements (meds must be in original box with dosage instructions and doctor s infosee med form) Flashlight Sunglasses UV Protective Lip Balm Sunscreen Pillow and Twin Bedding or Sleeping Bag Hiking shoes (if you have them) Tennis shoes Light jacket/rain Jacket or Poncho Towels/Washcloths Clothes for 3 Days plus a few extra clothes (consider that it gets very cool at night - dress code attached on back, shorts must clear fingertips) Toiletries Notebook, Pen/Pencil Water Bottle VERY important! (Talk to your kids about the importance of drinking a lot of water in high altitudes.) Bible (digital Bibles not allowed) Arrive at Rocky s Niwot Campus at noon on July 25. What should we bring to Camp Como? PACKING LIST

3 Medication Form Due 2 weeks before camp Camper Name Dates Attending Camp: July 25-28, 2017 Church Registered With: Rocky Mountain Christian Church PLEASE WRITE, "NONE" ACROSS THE FORM IF APPLICABLE. THIS FORM IS REQUIRED REGARDLESS IF CAMPER BRINGS MEDS TO CAMP. CAMP PERSONNEL TO COMPLETE P.O. Box 36, Como, CO Circle one: Camper Adult Faculty TLC Staff camp@campcomo.com Age Allergies Fax Indicates rescue inhaler was checked in & person is allowed to carry with them. NOTES: CAMP MEDICAL STAFF SIGNATURE: PHYSICIAN/CNP MUST LIST ALL MEDICATIONS BELOW, INCLUDING OTC, VITAMINS, HERBS, HOMEOPATHICS, ETC. Rx Med: Dosage: Route: L Start Date: End Date: D Treatment for: CAMP PERSONNEL B HS PRN SUN MON TUE WED THU FRI SAT Contra indications: Beginning count of medication = Ending count of medication = PRESCRIBING PHYSICIAN/CNP S SIGNATURE: Remaining meds were give to at checkout. Date Phone ( ) Printed Name Address City State Zip Rx Med: Dosage: Route: L Start Date: End Date: D Treatment for: CAMP PERSONNEL B HS PRN SUN MON TUE WED THU FRI SAT Contra indications: Beginning count of medication = Ending count of medication = PRESCRIBING PHYSICIAN/CNP S SIGNATURE: Remaining meds were give to at checkout. Date Phone ( ) Printed Name Address City State Zip PARENT/GUARDIAN'S SIGNATURE: Please use additional forms if necessary. Date Printed Name Rev. 1/17

4 Physical Form Due 2 weeks before camp P.O. Box 36, Como, CO camp@campcomo.com The COLORADO DEPARTMENT OF HUMAN SERVICES DIVISION OF CHILD CARE mandates that the camper s parent/guardian provide a health history to Camp Como as well as a statement confirming a physical examination has been performed within the preceding 24 months by a licensed physician or a qualified licensed nurse practitioner demonstrating that the camper is capable of attending camp. Current written authorization from the medical provider for any required prescription or non-prescriptive medicines is mandatory. Camper Name: Dates Attending Camp: July 25-28, 2017 Church Registered With: Rocky Mtn Christian Church TO BE COMPLETED BY A PHYSICIAN/CNP Medical conditions Camp Como should be aware of: List any serious illnesses or operations and dates: Special instructions (e.g. dietary restrictions, exempted activities, etc.) Allergies (i.e. drugs, food, other): was given a physical examination on / /. (Must be within 24 months of designated camp.) S/he is capable of active participation in a regular camp program except as noted above. Signature of Physician/CNP Date Printed Name Address Phone ( ) City State Zip Attach copy of current immunization record. Rev. 1/17

5 COLORADO LAW REQUIRES THAT THIS FORM BE COMPLETED FOR EACH STUDENT ATTENDING COLORADO SCHOOLS Name Date of Birth Parent/Guardian COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT CERTIFICATE OF IMMUNIZATION Vaccine Enter the month, day and year each immunization was given Hep B Hepatitis B DTaP Diphtheria, Tetanus, Pertussis (pediatric) DT Diphtheria, Tetanus (pediatric) Tdap Tetanus, Diphtheria, Pertussis Td Tetanus, Diphtheria Hib Haemophilus influenzae type b IPV/OPV Polio PCV Pneumococcal Conjugate MMR Measles, Mumps, Rubella Measles Measles Mumps Mumps Rubella Rubella Varicella Chickenpox Healthcare Provider Documentation Date Lab Verification Date Vaccines recorded below this line are recommended. Recording of dates is encouraged. HPV Rota MCV4/MPSV4 Hep A TIV/LAIV Human Papillomavirus Rotavirus Meningococcal Hepatitis A Influenza Other THIS SECTION CAN BE COMPLETED BY CHILD CARE/SCHOOL/HEALTH CARE PROVIDER A) Child Care Up to Date Up to date through 6 months of age for Colorado School Immunization Requirements Update Signature Date B) Child Care Up to Date Up to date through 18 months of age for Colorado School Immunization Requirements Update Signature Date C) Child Care/Pre-school/Pre-K Up to date for Child Care/Pre-School/Pre-K for Colorado School Immunization Requirements Update Signature Date D) Complete for K 5th Grade Up to date for K 5th Grade for Colorado School Immunization Requirements Update Signature Date If age 4 years and fulfills Requirements for Pre-School & Kindergarten, check BOTH Boxes C and D. HAS MET ALL IMMUNIZATION REQUIREMENTS FOR COLORADO SCHOOLS (6TH GRADE OR HIGHER) Signed Title Date (Physician, nurse, or school health authority) CDPHE-IMM CI RC Rev. 5/13

6 Name Date of Birth Parent/Guardian STATEMENT OF EEMPTION TO IMMUNIZATION LAW (DECLARACIÓN RESPECTO A LAS EENCIONES DE LA LEY DE VACUNACIÓN) IN THE EVENT OF AN OUTBREAK, EEMPTED PERSONS MAY BE SUBJECT TO ECLUSION FROM SCHOOL AND TO QUARANTINE. SI SE PRESENTA UN BROTE DE LA ENFERMEDAD, ES POSIBLE QUE A LAS PERSONAS EENTAS SE LES PONGA EN CUARENTENA O SE LES ECLUYA DE LA ESCUELA. MEDICAL EEMPTION: The physical condition of the above named person is such that immunization would endanger life or health or is medically contraindicated due to other medical conditions. EENCIÓN POR RAZONES MÉDICAS: El estado de salud de la persona arriba citada es tal que la vacunación significa un riesgo para su salud o incluso su vida; o bien, las vacunas están contraindicadas debido a otros problemas de salud. Medical exemption to the following vaccine(s): La exención por razones médicas aplica a la(s) siguiente(s) vacuna(s): Hep B DTaP Tdap Hib IPV PCV MMR VAR Signed (Firma) _ Physician (Médico) Date (Fecha) RELIGIOUS EEMPTION: Parent or guardian of the above named person or the person himself/herself is an adherent to a religious belief opposed to immunizations. EENCIÓN POR MOTIVOS RELIGIOSOS: El padre o tutor de la persona arriba citada, o la persona misma, pertenece a una religión que se opone a la inmunización. Religious exemption to the following vaccine(s): Exención por motivos religiosos de la(s) siguiente(s) vacuna(s): Hep B DTaP Tdap Hib IPV PCV MMR VAR Signed (Firma) _ Parent, guardian, emancipated student/consenting minor (Padre, tutor, estudiante emancipado o consentimiento del menor) Date (Fecha) PERSONAL EEMPTION: Parent or guardian of the above named person or the person himself/herself is an adherent to a personal belief opposed to immunizations. EENCIÓN POR CREENCIAS PERSONALES: Las creencias personales del padre o tutor de la persona arriba citada, o la persona misma, se oponen a la inmunización. Personal exemption to the following vaccine(s): Exención por creencias personales de la(s) siguiente(s) vacuna(s): Hep B DTaP Tdap Hib IPV PCV MMR VAR Signed (Firma) _ Parent, guardian, emancipated student/consenting minor (Padre, tutor, estudiante emancipado o consentimiento del menor) Date (Fecha)

TO BE COMPLETED BY A DOCTOR OR CNP. Medical conditions Camp Como should be aware of: List any serious illnesses or operations and dates:

TO BE COMPLETED BY A DOCTOR OR CNP. Medical conditions Camp Como should be aware of: List any serious illnesses or operations and dates: Physical Form Due 2 weeks before camp P.O. Box 36, Como, CO 80432 Email camp@campcomo.com Fax 719-836-0461 The COLORADO DEPARTMENT OF HUMAN SERVICES DIVISION OF CHILD CARE mandates that the camper s parent/guardian