2021 GROUP APPLICATION Church Name* Church Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Name of Group Leader:* First Last Best Way to Contact Direct Line Cell Phone Email Direct LineCell PhoneEmail Address Have you brought a group to Barnabas before? Yes No What year(s)? How did you hear about Barnabas?I want to learn more about Barnabas marketing resources and incentives to recruit my mission team! Yes No 2021 Camp Schedule: Please select your top 3 choices Term 1 Legends Week: May 29 - June 4 ($275 SPECIAL PRICE) Term 2 Heroes Week: June 5 - 11 ($275 SPECIAL PRICE) Term 3 Young Friends Week: June 12 - 18 ($295) Term 5 Soaring Hawks Week: June 26 - July 2 ($295) Term 6 Bridge Builders Week: July 10 - 16 ($295) Term 7 Explorers Week: July 17 - 23 ($295) Term 8 Champions Week: July 24 - 30 ($295) Term 9 Celebration Week: July 31 - August 6 ($275 SPECIAL PRICE) Out of the three you picked, which would be your 1st preference? Group Registration Fee Schedule February 1, 2021 $100 Per Position April l, 2021 50% of Total Group Balance Due May 1, 2021 Remaining Amount Due Please list the number of people for each position that you are committed to bringing. Groups must have a minimum of 10 positions. Our campers are counting on you, so please only list numbers you feel absolutely confident you can fill. Please have an equal ratio of males and females for each position unless otherwise informed and agreed upon. This is a MUST due to cabin space. Number of FEMALE Barnstormers (14-15)*Number of MALE Barnstormers (14-15)**Barnstormers may be 13 if they have graduated 8th grade.Number of FEMALE 1-on-1 Counselors (16-20)Number of MALE 1-on-1 Counselors (16-20)Number of FEMALE Adult Leaders (30+)**Number of MALE Adult Leaders (30+)****Please limit 1 adult to every 10 studentsIn addition to the roles listed above, I have a registered nurse or physician that would like to attend. Yes No NOTE TO GROUP LEADER: Please make sure this individual contacts our Health Services Director at [email protected] to get more information.By checking the following boxes, you signify agreement with the statements under each box.* I understand that the cost of camp is $295 per position (or $275 for weeks 1, 2, and 9).I understand that $100 per position and a signed contract are due by February 1, 2021 or 30 days after receipt of contract if after January 1. This fee is non-refundable.* I understand that $100 per position and a signed contract are due by February 1, 2021 or 30 days after receipt of contract if after January 1. This fee is non-refundable.I understand that 50% of our balance will be due April 1, 2021.* I understand that 50% of our balance will be due April 1, 2021.I understand my youth must complete individual registration by May 1, 2021.* I understand my youth must complete individual registration by May 1, 2021.I will stay in regular communication with the Missions Director regarding the number of spots my group can fill as well as any changes that may occur. As a reminder the $100 registration fee is non-refundable.* I will stay in regular communication with the Missions Director regarding the number of spots my group can fill as well as any changes that may occur. As a reminder the $100 registration fee is non-refundable. I understand that if anyone on our team cancels I will do my best to replace that team member with someone who is the same gender and in the same age range of the canceled position. I also understand that I need to notify the Missions Director of any cancellations as soon as possible.* I understand that if anyone on our team cancels I will do my best to replace that team member with someone who is the same gender and in the same age range of the canceled position. I also understand that I need to notify the Missions Director of any cancellations as soon as possible.I understand that if there is a cancellation the credit can be applied for later week or the following year.* I understand that if there is a cancellation the credit can be applied for later week or the following year.I understand that if we are selected and decide not to attend I need to notify the Missions Director immediately. Depending on the date, the credit can be applied for a later week or the following year.* I understand that if we are selected and decide not to attend I need to notify the Missions Director immediately. Depending on the date, the credit can be applied for a later week or the following year.I understand that each person who requires a special diet will be charged $100 on top of the $295 or $275 charge.* I understand that each person who requires a special diet will be charged $100 on top of the $295 or $275 charge.I understand that a criminal background check will be completed on every individual 18 or older. The cost of each background check is included in the $295/275 fee.* I understand that a criminal background check will be completed on every individual 18 or older. The cost of each background check is included in the $295/275 fee.I have read the Barnabas participant policies and standards and I agree that all members of my team must abide by these policies. I will review these policies with my team.* I have read the Barnabas participant policies and standards and I agree that all members of my team must abide by these policies. I will review these policies with my team.I have read, prayed over my decision, and accept the terms of this contract.* I have read, prayed over my decision, and accept the terms of this contract.E-Signature (type your name below to agree to the above conditions):*
