Camper Name *Street Address *Apartment, suite, etcCityState/ProvinceZIP / Postal CodeCountry AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemen Arab Rep.Yemen DemocraticZambiaZimbabwePhone *Email Address *GenderMaleFemaleDate of Birth *Grade (One they are FINISHING this school year) *What grade are they finishing in 2022-20230 / 2T-Shirt Size *T-ShirtsYouth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult XLAdult 2XT-ShirtsIs this the first time away from home?YesNoIs this the first time at Camp OOTB?YesNoWhat type of swimmer is your Camper?BeginnerIntermediateAdvancedWhat week of camp are you applying for? Choose all you plan on attending.Elementary Camp I (June 16-21)- Completing Grades 3-5Elementary Camp II (June 23-28) - Completing Grades 3-5Elementary Camp IV (July 7-12) - Completing Grades 3-5Elementary Camp VI (July 21-July 26)Elementary Sports Camp VII (July 28-August 2) - Completing Grades 3-6Middle School Camp I (June 16-21) - Completing Grades 6-8Middle School Camp II (June 23-28) - Completing Grades 6-8Middle School Camp IV (July 7-12) - Completing Grades 6-8Middle School Camp VI (July 21-26) - Completing Grades 6-8High School Camp (Busch Gardens) III (June 30-July 5) - Completing Grades 9-12Pocomoke River Adventure Camp V (July 14-20) - Completing Grades 9-12Older Sports Camp VII (July 28-August 2) - Completing Grades 7-12Girls Only (August 4- August 9) (Grades 3-12)Day Camp 1 (June 17-21)Day Camp II (June 24-28)Day Camp III (July 1-5)Day Camp IV (July 8-12)Day Camp V (July 15-19)Day Camp VI (July 22-26)Day Camp VII (July 29 - August 2)Day Camp VIII (August 5-9)LEAP Day Camp I (June 7-21)LEAP Day Camp II (June 24-28)LEAP Day Camp III (July 1-5)LEAP Day Camp IV (July 8-12)LEAP Day Camp V (July 15-19)LEAP Day Camp VI (July 22-26)LEAP - Day Camp VII (July 29-August 2)LEAP Day Camp VIII (August 5-August 9)Descriptions are on Summer Camp pages www.ootbay.org **PLEASE NOTE: Our Day Camp for kids Ages 4-6 are Currently FULL and you will be placed on a waiting list if you select this option**Is there anything we need to know to help your camper have a fun, safe and enjoyable week?Does the camper have a registered cabin buddy they would like to stay with?I would like the Virginia Beach Pick Up option for transportation from Virginia Beach United Methodist Church to CampNoYesPayment? *How do you intend on paying?Cash (Before or at Registration)Check (Before or at Registration)OtherWill your church be covering some/all of registration?Health FormA PARENT OR GUARDIAN MUST COMPLETE THIS FORM. THE DIRECTORS, HEALTH COORDINATOR AND CAMP COUNSELORS WILL HOLD INFORMATION FROM THIS FORM CONFIDENTIAL. THE INTENT OF THIS FORM IS TO PROVIDE THE CAMP DIRECTOR AND HEALTH COORDINATOR THE INFORMATION NEEDED TO PROVIDE APPROPRIATE EMERGENCY CARE. KEEP A COPY OF THIS FORM FOR YOUR RECORDS. ATTACH ADDITIONAL PAGES OR DESCRIPTIONS AS NEEDED. PROVIDE CHANGES TO THIS FORM TO THE HEALTH COORDINATOR AT CHECK- IN ON THE FIRST DAY OF CAMP.Does your child have any Dietary Restrictions? *List Any Known Allergies and Reactions *Health Insurance CompanyGroup Number / Policy NumberName of Physician & Phone NumberDiet & NutritionEats a regular dietVegan (no meats, seafood, eggs, or dairy)Vegetarian (no meats)Gluten-Free (Celiac)Gluten-Free (Allergy or Preference)Dairy FreeDoes your camper....Medical HistoryDo you attest that all immunizations required for school are up to date for this camper? *YesNoWill you be providing any over the counter medications or prescriptions medications for your camper?YesNoDoes your child have any special needs or issues including physical, emotional, health or behavior that the Camp Director should know?YesNoPlease describe any special needs or issues including physical, emotional, health or behavior that the Camp director and Staff should know about in advanced:Medical History:Has no health concernsAsthmaHeadaches, migranesSeizure disorderDysmenorrheaDiabetesBed wettingFaintingDepressionOtherIf there are other Medical Conditions please describe below:Describe any other past or current injury, illness, disease, treatment, surgery, or affliction the camp should know about in case of emergency. *OOTB Employees have permission to provide routine first aid and include applications of:Hydrocortisone CreamNeosporinCalamine LotionTECNU (Cream for poison ivy, sumac, oak)TylenolMelatoninNo Call Me FirstChurch MembershipChurch NamePastor's NameChurch location or townHow did you hear about OOTB?Emergency Contact InformationWho do we contact in case of emergency?Emergency Contact 1 *Phone *Email Address *Relation to CamperEmergency Contact 2PhoneEmail AddressRelation to CamperParent/Guardian InformationPrimary Parent/Guardian *Street Address *Apartment, suite, etcCityState/ProvinceZIP / Postal CodeCountry AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemen Arab Rep.Yemen DemocraticZambiaZimbabweEmail Address *Home Phone *Cell Phone *Send Message