2015 OZARK MISSION PROJECT YOUTH GROUP APPLICATION

2015 OZARK MISSION PROJECT YOUTH GROUP APPLICATION
Camp Registration opens October 15, 2014
Print the three page application. Complete and return to the address provided.
Make a copy of the application for your files.
Name of Church ______________________________________________________________________________________________
Church Address_______________________________________________________________ Phone_________________________
Street
City
Zip
Adult in Charge__________________________________________________ Email Address_____________________________
Home Address _______________________________________________________________________________________
Street
City
Zip
Contact Numbers: Cell _______________________Office_______________________Home________________________
Approximately how many participants will be in your group?
Note: 1 adult with vehicle & tools must accompany every 4 youth.
Adults _____ Youth: 12th _____ 11th _____ 10th _____ 9th _____ 8th _____ *7th_____*6th_____ TOTAL ________
*Youth must have completed the 6th or 7th grades to register for Middle School Camps.
*Youth must have completed the 8th grade and up to register for Sr. High Camps.
(May attend through Freshman Year of College)
Total Number of Participants _________ x $50.00 = $ ______________. Deposit must accompany Application.
Note: By May 1, a Camp Roster must be sent to the Mission Coordinator at [email protected].
Camp Rosters can be found on our website at ozarkmissionproject.org/youthdirectors.
Background Check and Safe Sanctuary Training
OMP wants to ensure a safe mission experience for our campers. All adult campers are required to complete a
background check, child maltreatment registry check, and online safe sanctuary training. A verification form for
your church to fill out is included in this packet. If your church does not currently do background checks and child
maltreatment registry checks, please contact the Mission Coordinator at 501-499-9292 or
[email protected] to learn how to get this done.
Go to www.arumc.org for the Arkansas Conference online safe sanctuary training; to the Resource tab; Safe
Sanctuaries; create a login & password; read the material then take the 10 question quiz; print the certificate; give
it to the adult in charge at your church.
OZARK MISSION PROJECT
BACKGROUND CHECK VERIFICATION FORM
In order to promote a safe environment for all youth and adult participants at Ozark Mission Project, each church
must certify that it has conducted a background check on all persons who are 18 years or older or who will be
chaperoning or working with youth at camp. The background check must include a criminal background check as
well as a child maltreatment registry check.
OMP Camp and Date___________________________________________________________
Church Name_____________________________________________________________________________
Church Address___________________________________________________________________________
Church Phone____________________________________________________________________________
Please print the name of each person 18 years or older or who will be chaperoning or working with youth,
including yourself, attending the event identified above.
1.______________________________________
3.______________________________________
5.______________________________________
7.______________________________________
2._______________________________________
4._______________________________________
6._______________________________________
8._______________________________________
I, _______________________________ (Youth Leader's Name) acknowledge that
__________________________________ (Church Name) has conducted a criminal background check and a child
maltreatment registry check on all persons who will be chaperoning or working with youth at Ozark Mission Project on
____________________________(Date of Event) and all such participants have been approved by the local church to work
with children, youth and other adults. We agree to indemnify, protect and hold harmless Ozark Mission Project for any
liability related to any action of any participant being sent by _______________________________ (Church Name).
TWO separate signatures are REQUIRED.
1._______________________________________________________________________________________
Trip Leader's Signature
Date
2. _______________________________________________________________________________________
Senior Pastor or Associate Pastor
Date
(Other than, and not related to, the Trip Leader)
Send a copy of this completed form to:
Ozark Mission Project
Attn: Douglas Turner
Mission Coordinator
PO Box 26525
Little Rock, AR 72221
2015 CAMP SCHEDULE
Indicate your camp preference by selecting 1st, 2nd, and 3rd as your choice.
Complete pages 1 and 2 for each group registered; one page 3 can be used for multiple groups.
Week One:
June 7-11, 2015 Middle School Camp for 6th & 7th Grade
_______ Shoal Creek Camp (Central AR) located near Dardanelle, AR
June 7-13, 2015 Sr. High Camps for 8th_12th Grade
_______ Lakewood UMC (Central AR) located in North Little Rock, AR
_______ Bear Creek Camp (East Central AR) located in Marianna, AR
_______ West Memphis FUMC (East Central AR) located in West Memphis, AR
Bonus Week:
June 14-20, 2015 Sr. High Camp for 8th-12th Grade
_______ Blytheville FUMC (North East AR) located in Blytheville, AR
Week Two:
June 21-25, 2015 Middle School Camp for 6th & 7th Grade
_______ Harrison FUMC (North Central AR) located in Harrison, AR
June 21-27, 2015 Sr. High Camps for 8th-12th Grade
_______ Winfield UMC (Central Arkansas),located in Little Rock, AR
_______ Piney Grove UMC (Central, AR) located in Hot Springs, AR
_______ Siloam Springs FUMC (Northwest AR) located in Siloam Springs, AR
Week Three:
July 12- 16, 2015 Middle School Camp for 6th & 7th Grade
_______Wayland Springs Camp (Northeast AR) located near Imboden, AR
July 12- 18, 2015 Sr. High Camps for 8th-12th Grade
_______ Cornerstone UMC (North East AR) located in Jonesboro, AR
_______ Cabot FUMC (Central AR) located in Cabot AR
_______ Camden FUMC (Southwest AR) located in Camden, AR
Feel free to make comments about your choices below.
 Training and t-shirt pickup information will be sent at a later date.
YOUTH GROUP COVENANT WITH OZARK MISSION PROJECT
In submitting this application to become part of Ozark Mission Project, our Youth Group agrees:
1. We agree to participate in training prior to our attendance at OMP. We understand that details will be provided at a
later date.
2. We will provide 1 vehicle with at least 5 seatbelts and 1 driver for every 4 youth. We understand this vehicle must
have adequate space for at least 5 campers, tools, ice chest, lunch food bag, and building supplies. We will be
responsible for vehicle expenses during the camp week. We will verify adult drivers possess current driver’s license
and proof of vehicle insurance.
3. We will bring Vehicle Tools to camp that are in good working condition.
4. Ozark Mission Project reserves the right to remove campers from camp and send them home without a refund should
their actions break the rules, damage property, and/or endanger themselves, their peers, or our staff.
5. We will abide by the following payment schedule:
$50/person deposit with this application
$100/person - second payment by March 1, 2015
$65/person – Middle School Camp Final payment by May 1, 2015
$100/person - Sr. High Camp Final payment by May 1, 2015
We will be responsible for paying for all campers registered as of March 1, 2015.
Payments are non refundable. Payments can be made in full if you prefer.
Please share the above dates & amounts with the person who writes your checks.
This application should be signed by a youth and adult camper attending OMP. A representative of your church Finance
Committee should sign to indicate that your church will be responsible for paying $215/Middle School camper and/or
$250/Sr. High camper registered as of your March 1, 2015 payment. The signature of your Pastor signifies the adult campers
attending OMP are deemed mature, responsible, and caring adults who will behave as such.
________________________________________
Youth Representative Signature & Date
________________________________________
Adult Representative & Date
____________________________________________________
Finance Representative Signature & Date
_____________________________________________________
Pastor’s Signature & Date
Make check payable and mail to:
Ozark Mission Project
PO Box 26525
Little Rock, AR 72221
You will be notified of camp assignments January 2015 or earlier if possible.
Applications will be processed according to postmark date.
We look forward to hearing from you soon!
Note: If you do not receive an email or phone call confirming your application has been received
10 days from your postmark date please contact the Douglas Turner, Mission Coordinator at 501-664-3232 or
[email protected]

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