STAMPEDE WINTER CAMP January 31-February 2, 2014 Lake Geneva, Wisconsin
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CHRIST CHURCH OF OAK BROOK MIDDLE SCHOOL MINISTRY
STAMPEDE WINTER CAMP
January 31–February 2, 2014 Lake Geneva, Wisconsin
W H AT I S C O W ?
COW (Cloud Of Witnesses – Hebrews 12:1–3) isn’t a place or thing, it’s people: middle schoolers
and amazing staff who gather each week to learn, play, laugh, entertain, focus, and journey together as
followers of Jesus Christ. We believe middle schoolers have real lives, real passions, real problems, real
questions, real relationships, real interests, real potential, and are capable of living a real life that reflects a real
relationship with Jesus! More important than what we think, is what God thinks about you…God loves you!
Pete Stearns, Middle School Coordinator
630.321.3927
Christ Church of Oak Brook Middle School Ministry
501 Oak Brook Rd, Oak Brook, Il 60523
Register with a $50 non‐refundable deposit by December 25 and save $25
STAMPEDE WINTER CAMP 2014 STAMPEDE WINTER CAMP FAQ
stam·pede (stam pēd’) noun. American Spanish estampida, from Spanish, crash, from estampar, to stamp.
1: A wild, headlong scamper of a number of animals What is included in the event registration fee?
2: A mass movement of people at a common impulse The fee includes charter coach bus transportation, two nights lodging, five meals,
3: A life–changing, action–packed weekend focused on helping you grow closer to God while creating fun–filled memories with
official Stampede Memorabilia, camp guidebook and all onsite activities.
your friends. You will be challenged to take risky steps of faith and be courageous in living the life God created you to enjoy! We
want you to be able to go home from Stampede saying,
“I remember God did something in my heart, and it happened at Stampede!” Can I pay my registration fee by credit card?
Christ Church of Oak Brook accepts Visa, MasterCard, and Discover. Please contact
Terry Koshgarian (630.654.1882) in the main office to make a payment.
How can I apply for financial aid?
Need‐based assistance is provided to families in difficult financial situations. We
know that many people are facing tough financial times and we don’t want money
to hinder any student from attending Stampede. If you are in need of financial aid,
please request a financial aid form from either Laurie or Pete!
Will my child need spending money for Stampede?
The Snack shop will be open during free times and $10–$25 cash is appropriate.
Can my student check‐in late or leave early from Stampede?
We ask that you make every effort to have your child attend the entire event to
ensure the best experience possible. Missing any part of the weekend can detract
from the community bonding experience that Stampede is centered around.
Exceptions can be made through Pete Stearns (pstearns@cc‐ob.org or
630.321.3927).
Can my child be assigned a cabin with their friend?
Students are assigned to cabins by grade and gender.
COVENANT HARBOR BIBLE CAMP, LAKE GENEVA, WISCONSIN
Covenant Harbor is less than two hours away by chartered coach bus – barely enough time to watch a movie! The camp fea‐
tures cozy warm cabins, tubing, sledding, ice skating, broomball, game room, snack shop, rock climbing, laser tag, giant swing, What adults will be at Stampede?
brand new gym for basketball, volleyball, and of course crazy games! With hours of free time, you’ll find plenty to do. Our camp staff are the same amazing volunteers who serve in our Middle School
Ministry each week. We believe that consistent relationships with kids are the key BRING 110
to helping them take the next steps in their faith. We strive to maintain a staff/
student ratio of 1:6 with volunteers who have submitted to background checks. CAMPERS TO
When will I receive my final confirmation e–mail?
STAMPEDE
Final details and packing lists will be e–mailed on January 24, 2014. AND GO FOR A
What time will drop–off and pick–up take place?
Check–in begins Friday, January 31 at 6:00pm. The buses will depart the church at
LOONY DOOK!
6:30pm. Please eat dinner prior to arriving – we will not be making stops. We will
arrive home on Sunday, February 2 at 3:00pm. Yes, Pete will embrace his fear of the
wintery depths by diving into the
What if I have some more questions? freezing waters of Lake Geneva! In
Registration Contact: Laurie Lamm 630.321.3933 or llamm@cc‐ob.org fact, if we meet the challenge,
Program Contact: Pete Stearns 630.321.3927 or pstearns@cc‐ob.org everyone is invited to join in the
Loony Dook! Fill out a release form
BRANDON HALL SPEAKER DAVID LEE BAND WORSHIP and you’ll be able to say you belong
Brandon Hall is an incredibly gifted Middle School
youth pastor from Seattle Washington. He has a
huge heart for students and is really looking forward
David Lee is an extraordinary Youth Worship Leader.
David and Pete were classmates at Wheaton College,
and are excited to be working together at Stampede.
DECK THE HALLS to the exclusive Loony Dook Club!
A Loony Dook is what the Scottish call a
“Lunatic Dunk.” You can wear whatever
to sharing at Stampede. Brandon and Pete went to
High School together in Seattle, and Brandon taught
Pete all he knows about Christian rap! The last time
David works to bring an incredible worship experience
that our students can engage with in a powerful way.
We are looking forward to singing many of our favorite
DISCOUNT crazy outfit you want as you jump into the
icy waters of Lake Geneva in front of all
your friends! The entire activity is safe and
Brandon saw snow was in 2007 while sledding with songs from past retreats, as well as learning a few new Register with a $50 deposit by December supervised by emergency personnel.
Pete, he was so cold that he had to borrow one of
Pete's coats… Wisconsin in February should be fun :)
ways to worship our incredible God. We are so
fortunate to have a God that loves to hear our praise!
25 and save $25!
2014 STAMPEDE WINTER CAMP REGISTRATION OFFICE USE ONLY
DATE
Full Name: RECEIVED:
Date of Birth: Gender: F M
Address:
City: Zip Code:
Home Phone:
School: Grade: 6 7 8
PAYMENT ENCLOSED REGISTRATION POLICY
$165 Early–Bird Registration (11/26—12/25) • A $50.00 non–refundable deposit is due at registration.
$190 Regular Registration (12/26—1/27) • Full payment is due no later than 1/27/2014 .
Check $_______________ Check #_______________ • Space is limited and registrations will be accepted on a first
Please make checks payable to: Christ Church of Oak Brook come, first serve basis.
• Cancellations made before 1/27/2014 will receive a full
Cash $_______________ refund minus the non–refundable deposit of $50.00.
Credit Card $______________ • Cancellations made after 1/27/2014 will receive no refund.
Please contact the CCOB Main Office to pay by credit card. Exceptions may be made for medical reasons.
PARENT PERMISSION & MEDICAL RELEASE
The undersigned gives permission to his or her child to participate in the named activity and releases Christ Church of Oak Brook,
it officers, employees and agents from any liability whatsoever for any injury or death to person or loss or damage to property
sustained by the undersigned or any member of his/her family in attendance, and the undersigned agrees to defend and
indemnify Christ Church of Oak Brook, its officers, employees and agents any liability or loss they might sustain by reason
thereof. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the Middle
School Pastor to hospitalize, secure proper treatment for, and to order injection, anesthesia or surgery for my child as named
above. By signing this permission form, the undersigned understands that still images or video taken on trips may be used by
Christ Church of Oak Brook in internal, printed materials, as part of a visual or auditory presentation or as a depiction of a regular
church activity. I understand and agree that this will become the exclusive property of the organization named above and that I
am to receive no compensation or remuneration for my participation, or that of my child.
Parent Signature: Date:
Mother’s Name: Mobile Phone:
Father’s Name: Mobile Phone:
*This e‐mail will be used to send event notifications.
E‐mail:*
Insurance Carrier: Group #:
Allergies or Medical Concerns:
Dietary Restrictions:
Emergency Contact: Phone:
Please attach a copy of both sides of your insurance card. Thank you.
Christ Church of Oak Brook ∙ 501 Oak Brook Rd, Oak Brook, IL 60523 ∙ 630.654.1882 ∙ www.cc‐ob.org
Covenant Harbor Waiver
Participant Information
Name Group
Address
City/State Zip
Phone Age if under 18
Any limitations to participation? (physical, medical, behavioral)
Any allergies? (food, drug, environmental)
If food allergy: Mild / preference / guest can self manage Moderate / guest can self manage Serious / life threatening
Other participation concerns?
Emergency Contact Relationship Phone
Wisconsin statute HFS 175.15 requires camps obtain names and home address of every participant including emergency contact information.
Release and Waiver of Liability
I hereby give my consent to have the above-named Participant fully participate in all camp activities, outings and field trips conducted on and off the
campus of Covenant Harbor recognizing that there are risks known and unknown, foreseeable and unforeseeable involved in participating in these or
similar activities. Covenant Harbor has taken reasonable and prudent steps to reduce known and foreseeable risks. I understand activities may be
strenuous and/or outdoors and agree that participation in activities is voluntary. I understand and agree that neither Covenant Harbor nor its trustees,
officers, directors, employees, agents or representatives may be held liable in any way for any injury, harm, damage or death which may occur to the
above Participant as a result of participation in these activities and hereby release, save and hold harmless the above mentioned of said injury due to
participation in these activities. Further, I do consent to any and all medical treatment that may be deemed necessary for the Participant should he/she
require such assistance. I agree that my insurance plan is the primary plan to pay for the medical, dental or hospital care or treatment that is given to the
Participant. I agree to allow Covenant Harbor to transport Participant as needed and to use a photocopy of this form as my authorization when
necessary. Covenant Harbor may use the Participant’s photo, films, digital images, videotapes and sound recordings in future promotional materials. I
have read and voluntarily agree to the statements herein.
Participant Signature/
Legal Guardian (if minor): Printed Name: Date:
1724 W. Main St. Lake Geneva, WI 53147 Phone 262.248.3600 Fax 262.248.6814 covenantharbor.org
REQUIRED FOR REQUIRED FOR
POLAR BEAR DIP POLAR BEAR DIP
PARTICIPANTS ONLY PARTICIPANTS ONLY
Acknowledgement of Risk, Assumption of Responsibility & Medical Information
Covenant Harbor Bible Camp and Retreat Center offers a variety of activities that include some risk. Those that
participate in activities at Covenant Harbor do so by their own choice, so the risk of injury must be assumed by the
individual. With the activity of the “Polar Bear Dip”, participants dunk themselves into the water in a hole cut in the
ice on the lake. Participants subject themselves to extreme cold temperatures during this activity. The hole in the ice
is approximately 4 feet by 4 feet located in shallow water approximately 3 to 4 feet deep so that participants can stand
as needed, or briefly dunk themselves underwater as desired. The ice is a minimum of seven inches thick. The activity
is supervised by Covenant Harbor-provided lifeguards.
Participants must wear shoes at all times. Participants must bring dry and warm clothes and a towel to the site so that
the participant may warm themselves as quickly as possible after dipping in the ice water.
Covenant Harbor will take reasonable precautions to mitigate risk of injury, including providing safety instructions
prior to the activity. This activity is physically demanding. Participants must be able to follow safety instructions
provided by Covenant Harbor staff and lifeguards. Participants must be physically able to jump into, and climb out of
the hole in the ice as described above. The Polar Bear Dip can be strenuous and is of a different nature than some
participants are used to.
We do not want you to engage in activities that would be detrimental to your health or which might be opposed by
your physician because of illness, injury, medical condition, pregnancy, medications, or surgery. Covenant Harbor
strongly urges participants to consult with their doctor prior to participating in the Polar Bear Dip to ensure that the
individual is able to participate safely. Participants of the Polar Bear Dip must have their own health insurance
coverage. We ask you for the following information so we can be aware of potential problems to better help you
safely enjoy your experience.
Name Group
Gender DOB
Address Phone
City/State Zip Code
In case of emergency, notify: Relationship
Home Phone Business Phone
Yes No Do you have Health Insurance? (Company)
Are there any reasons, medial or otherwise, that prevent the participant from participating in the Polar Bear Dip activity?
(Be specific)
I understand that aspects of the Polar Bear Dip are physically demanding and failure to follow instructions may result
in injury or even death. I affirm that the above medical information is true; that my health is good, and that there is no
known limitation that should restrict my participation. I also affirm that I am not under a physician’s care for any
undisclosed condition that bears upon my fitness to participate in the Polar Bear Dip. I understand that I will be
participating in activities outside in extreme environmental conditions, which may include sun, rain, wind, and snow
and in a range of temperatures. I understand that there are inherent risks in the Polar Bear Dip activity and I agree to
follow the directions and safety rules of leaders and cooperate with them.
Participant’s Signature Date
Participant’s Name (please print)
Parent/Guardian Signature Date
Covenant Harbor Bible Camp, 1724 W. Main, Lake Geneva, Wisconsin 53147
262-248-3600 www.covenantharbor.orgYou can also read
