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  SHELTER NECK UU CAMP
 Registration Form for Adults, Family, Children & Teens
 Registration deadline is ten days before an event.
 *Lines beginning with asterisks need not be completed by adults.
 
 Name: (Contact)___________________________________________
 Address: ___________________________ _________________________________Zip:___________________
 Phone Number & E-mail: ___________________
 Church: ________________________________________
 
 *Parent or Guardian Names (If not attending event): ____________________________________
 Their contact phone number: __________________________
 Alternate Emergency # ______________________
 
 # People registered with this (contact) Adults ____; 13-18 ______; 7-12 __________ 0-6 __________
 *Birthday(s) - (month/day/year): ______________, _____________, ________________, _______________
 
 Children 18 yr. Old and younger must agree to the Big 4 "easy to follow and still have fun rules."
 
 *! ! ! I agree to the Big 4 "easy to follow and still have fun rules:" *(1. no violence; 2. no alcohol or illegal drugs of any kind; 3. no tobacco products; 4. no sex)
Camper's Signatures: ________________________________
 ___________________________________________
ADVISOR'S SIGNATURE ___________________________
 
 Medical information and release form (We don't expect broken bones or bruised bodies but need this information--just in case!)
 
 Insurance Co.: _____________________________________
 ID #___________________________
 Group #_____________________________
 Care Card # __________________________
 
 Allergies, medical conditions, prescription medications, etc ___________________________________
 
 Date of last tetanus shot:________Doctor's Name and Phone: ________________________________
 
 *Authorization is hereby granted to provide whatever emergency medical treatment and/or hospitalization is deemed necessary for my minor child. The authorization is valid for (inclusive dates: ______________________)
 
 *Parent's or Guardian's Signature:__________________________
   Date:_______        Phone number:______________
 
 NOTES:
 
 Vegetarian?_________Any special diet or needs? (Please specify)____________________________________
___________________________________________
_______________________________________________
____________________________________________
______________________________________________
 
 For further information on an event, directions to Shelter Neck Camp, or brief history of Shelter Neck email:
  Camp Contacts
Pete Leary, Camp Supervisor: )919) 781-6494   guildmasters@mindspring.com
Susan Wasilewski, Events Info and Registration: susan_wasilewski@hotmail.com

Or see    www.ShelterNeckUUCamp.org

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(info from previous page)
Week-end subsidized and sponsored by UCONCI Board of Trustees.
Registration deadline is ten days before an event.
 All registration forms (downloadable below) should be mailed by deadline to:
 
 Susan Wasilewski, 7305 Fiesta Way, Raleigh, NC 27614
 
Make checks out to "UCONCI"
  Adults $35, Children Extra (0-6 free, 7 -12 $12, 13-18 $15...up to maximum of $100 per family)
  LATE FEE of $5 per person, if registered after deadline or on-site, so do it NOW!!!!!!
  Part-time visit (not overnight) Daily $10 + $5 per meal

 What to bring? Pillows, sheets or sleeping bags, towels, toiletries, personal snacks or beverages, flashlights, musical instruments, and if tenting, all your tenting stuff...
 
 Other Accommodations? For those who prefer more privacy or motel accommodations, the Holiday Inn Express at Wallace (about 10 mi. away) is very nice and reasonably priced. Located at the intersection of I-40 and NC 41, at exit 385, phone number is 910-285-9200, email address: holidayexpress@duplinnet.com.
Also  in Wallace is the Liberty Inn at 918 N Norwood St, ph- (910-285-7586)
 At Holland's Shelter Creek Restaurant and Outdoor Adventures, approximately 3 miles from Shelter Neck on HWY 53, RV hook-ups and almost new "rustic" cabins which sleep up to 4 people, with heat, air conditioning and indoor plumbing at $68 per night (double occupancy) are available. For further information see www.hollandssheltercreek.com or 910-259-5743.
 
 Special Needs? Please let us know if you are Vegetarian to help with menu planning.  Special diets and allergies-let us know if you will be bringing your own food. We need advance notice for diet food items--local groceries are limited in certain food selections!
 
 *Shelter Neck's 4 Easy-to-Follow and Still-Have-Fun Rules for Teens and Children: NO violence; NO alcohol or illegal drugs of any kind; NO tobacco products; NO sex
 ONE ADVISOR (over 25 years old) or PARENT for every 4 teens or children