2023 Children's Ministry Conference


It's time to LEVEL UP


Heartland Regional Children's Ministry Conference


$100 by 3/1/23


$125 after 3/1/23 or at the door.


Applicants will receive training certificates. 


March 23, 2023 2:00pm - March 26, 2023 12:00pm
March 22, 2023 11:00pm [Central Time]
Camp Kahoka
734 Ben Cartwright Lane
Mountain View AR 72560
Click for a larger map
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Billing and Payment
Billing and payment processing for Businesses' events is performed by Member Solutions, Inc. ("MSI"), and this contract is specifically assigned to MSI for all such purposes. Customer knowingly and irrevocably authorizes MSI to charge electronically Customer's bank account and/or credit card for any and all amounts due for Customer's, and anyone registering under Customer's, attendance and participation in the Event. Please note, you may see all or any portion of the following on your bank or credit card statement: "MSI*CHURCHOFGODOFPROPHEC 8882448044 ONLINE REG FEE". Any returned payment will be assessed a $25.00 fee. Any unsuccessful electronic transaction is subject to a $10.00 processing fee. MSI is not responsible for any bank fees incurred by Customer. MSI has the sole right to resubmit returned or declined items (plus applicable fees) without prior notice. BILLING INQUIRIES -- 888-244-8044 or by mail to PO Box 297, Hatboro, PA 19040.

Applicant Agreement
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Registration inquiries:
LaCinda Whittington
7217 Glenn Hills Drive
Sherwood AR 72120
870-219-5635
lacinda.whittington@hacogop.org
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Due to permission/legality issues, application MUST be completed by parent/guardian of registrants under 18 years old.
RHEUMATIC FEVER
DIABETES
ASTHMA
CONVULSIONS
SLEEP WALKING
TUBERCULOSIS
HEART PROBLEMS
IVY, OAK, SUMAC POISONING
FAINTING
KIDNEY PROBLEMS
BED WETTING
ADD/ADHD
OTHER: LIST BELOW
NONE
BEE/WASP STINGS
PENNICILLIN
MILK/DAIRY
FOOD: LIST BELOW
OTHER: LIST BELOW
NO ALLERGIES
MEDICAL CONSENT
IN THE CASE OF A MEDICAL EMERGENCY, I UNDERSTAND THAT REASONABLE EFFORT WILL BE MADE TO CONTACT EMERGENCY PERSON(S). IN THE EVENT THEY CANNOT BE REACHED, I GIVE PERMISSION TO CAMP KAHOKA ADMINISTRATION AND PHYSICIAN SELECTED TO SECURE ANY AND ALL PROPER MEDICAL TREATMENT FOR, TO ADMINISTER OTC OR PRESCRIPTION MEDICATIONS, TO HOSPITALIZE, ORDER INJECTION, ANESTHESIA, AND/OR SURGERY FOR REGISTRANT. I UNDERSTAND THAT MY INSURANCE HAS THE PRIMARY RESPONSIBILITY OF PAYMENT SHOULD REGISTRANT NEED TREATMENT. CAMP KAHOKA INSURANCE IS SECONDARY. I UNDERSTAND THAT IF ANYACCIDENT OR SICKNESS SHOULD OCCUR WHICH IS NOT COVERED BY INSURANCE, IT IS MY RESPONSIBILITY AND THE CAMP WILL NOT BE LIABLE FOR ANY OF THE EXPENSES INCURRED IN SUCH CASES.
PARENT OR GUARDIAN MUST SIGN IF UNDER 18

COVID STATEMENT & WAIVER 

CAMP KAHOKA HAS PUT IN PLACE PREVENTATIVE MEASURES TO REDUCE THE SPREAD OF COVID-19; HOWEVER, CAMP KAHOKA CANNOT GUARANTEE THAT YOU OR YOUR CHILD(REN) WILL NOT BECOME INFECTED WITH COVID-19. FURTHER, ATTENDING CAMP KAHOKA COULD INCREASE YOUR RISK OF CONTRACTING COVID-19. BY SIGNING THIS AGREEMENT, I ACKNOWLEDGE THE CONTAGIOUS NATURE OF COVID-19 AND VOLUNTARILY ASSUME THE RISK THAT MY CHILD(REN)/I MAY BE EXPOSED TO OR INFECTED BY COVID-19 BY ATTENDING CAMP KAHOKA AND THAT SUCH EXPOSURE OR INFECTION MAY RESULT IN PERSONAL INJURY, ILLNESS, PERMANENT DISABILITY, AND DEATH. I UNDERSTAND THAT THE RISK OF BECOMING EXPOSED TO OR INFECTED BY COVID-19 AT CAMP KAHOKA MAY RESULT FROM THE ACTIONS, OMISSIONS, OR NEGLIGENCE OF MYSELF AND OTHERS, INCLUDING, BUT NOT LIMITED TO, CAMP KAHOKA EMPLOYEES, VOLUNTEERS, AND PROGRAM PARTICIPANTS AND THEIR FAMILIES. 

I UNDERSTAND THAT MY CHILD(REN)/ I MUST BE FREE FROM COVID-19 SYMPTOMS, AND SHOULD SYMPTOMS DEVELOP WHILE IN THE CARE OF CAMP KAHOKA, MY CHILD(REN)/ I WILL BE SEPARATED FROM THE REST OF THE CAMP PARTICIPANTS/STAFF. I WILL BE CONTACTED, AND MY CHILD MUST BE PICKED UP WITHIN THREE HOURS OF MY BEING NOTIFIED. I FURTHER VOLUNTARILY AGREE THAT CAMP KAHOKA MAY MONITOR MYSELF OR MY CHILD(REN) FOR SYMPTOMS OF COVID-19 (INCLUDING, BUT NOT LIMITED TO, FEVER OF 100.4 DEGREES FAHRENHEIT OR HIGHER, SHORTNESS OF BREATH, CHILD, DRY COUGH, SORE THROAT, AND MUSCLE ACHES)

I WILL IMMEDIATELY NOTIFY CAMP MANAGEMENT IF I BECOME AWARE OF ANY PERSON WITH WHOM MY CHILD OR I HAVE HAD CONTACT EXHIBITS ANY SYMPTOMS OF COVID-19, IS ADVISED TO SELF-ISOLATE, QUARANTINE, OR HAS TESTED POSITIVE FOR COVID-19.

I VOLUNTARILY AGREE TO ASSUME ALL OF THE FOREGOING RISKS AND ACCEPT SOLE RESPONSIBILITY FOR ANY INJURY TO MY CHILD(REN) OR MYSELF (INCLUDING BUT NOT LIMITED TO, PERSONAL INJURY, DISABILITY, AND DEATH, ILLNESS, DAMAGE, LOSS, CLAIM, LIABILITY, OR EXPENSE, OF ANY KIND, THAT I MAY EXPERIENCE OR INCUR IN CONNECTION WITH MY ATTENDANCE AT CAMP OR PARTICIPATION IN CAMP PROGRAMMING ("CLAIMS”) ON MY BEHALF, I HEREBY RELEASE, COVENANT NOT TO SUE, DISCHARGE, AND FOREVER HOLD HARMLESS CAMP KAHOKA, CHURCH OF GOD OF PROPHECY, ITS BOARD, DIRECTORS, OFFICERS, EMPLOYEES, AGENTS, CONTRACTORS AND AFFILIATES AS WELL AS THE RELEASE PARTIES AND REPRESENTATIVES OF AND FROM THE CLAIMS, INCLUDING ALL LIABILITIES, CLAIMS, ACTIONS, DAMAGES, COSTS OR EXPENSES OF ANY KIND ARISING OUT OF OR RELATING THERETO. I UNDERSTAND AND AGREE THAT THIS RELEASE INCLUDES ANY CLAIMS BASED ON THE ACTIONS, OMISSIONS, OR NEGLIGENCE OF THE CAMP, ITS EMPLOYEES, AGENTS, AND REPRESENTATIVES, WHETHER A COVID-19 INFECTION OCCURS BEFORE, DURING OR AFTER PARTICIPATION IN ANY CAMP PROGRAM.

IN WITNESS WHEREOF EACH PARTY HERETO HAS EXECUTED THIS WAIVER BY ITS AUTHORIZED SIGNATORY AS OF THE DAY, MONTH, AND YEAR INDICATED BELOW, AND THE WAIVER BECOMES EFFECTIVE UPON THE DATE OF THE LAST SIGNATURE HERETO. PARENT OR GUARDIAN MUST SIGN IF UNDER 18.                                                      
REGULATIONS:  PROHIBITED ITEMS:
ELECTRONICS
FIREWORKS
ALCOHOL
DRUGS
TOBACCO
VAPES,
JUULS ETC.
GUNS
KNIVES
WEAPONS OF ANY KIND
CAMP STAFF RESERVES THE RIGHT TO PERFORM AN INSPECTION OF ALL BELONGINGS.
NO USE OF DRUGS, ALCOHOL, OR PROFANITY ALLOWED.
ITEMSTO BRING:
  • TOILETIRES
  • TOWELS & WASHCLOTHS
  • CASUAL CLOTHES
  • CLOSED-TOE SHOES
  • TWIN-SIZED BEDDING (SHEET, BLANKET, PILLOW, SLEEPING BAG)
  • BIBLE, PEN &PAPER
  • DONOT BRING:VALUABLES; JEWELRY, LARGE AMOUNTS OF CASH, COMPUTER, VIDEO GAMES, ANY ELECTRONICS
 

STATEMENT OF UNDERSTANDING, CONSENT, AND RELEASE 

I UNDERSTAND THAT CAMP KAHOKA IS A MINISTRY OF THE CHURCH OF GOD OF PROPHECY AND CONSEQUENTLY ALL ACTIONS, CONDUCT, AND POLICIES WILL BE CONSISTENT WITH THE CHURCH’S STATEMENT OF DOCTRINE AND BELIEFS. IN CASE OF AN EMERGENCY, I UNDERSTAND THAT EVERY EFFORT WILL BE MADE TO CONTACT ME (PARENT OR GUARDIAN). IN THE EVENT I CANNOT BE REACHED, I HEREBY GIVE PERMISSION TO CAMP KAHOKA ADMINISTRATION, DIRECTORS, STAFF AND PHYSICIANS SELECTED BY THE CAMP TO SECURE PROPER TREATMENT FOR, TO ADMINISTER "OVER-THE-COUNTER” (OTC) OR PRESCRIPTION MEDICATIONS, TO HOSPITALIZE, ORDER INJECTION, ANESTHESIA, AND /OR SURGERY FOR THE CAMPER.

I UNDERSTAND THAT MY INSURANCE HAS THE PRIMARY RESPONSIBILITY OF PAYMENT SHOULD MY CHILD/I NEED TREATMENT. THE CAMP INSURANCE IS SECONDARY. I UNDERSTAND THAT ALL MEDCIATIONS, INCLUDING OTC MUST BE ADMINISTERED BY THE CAMP MEDICAL PERSONNEL AND THAT MEDICATIONS WILL BE COLLECTED AT THE TIME OF REGISTRATION.

I CERTIFY THAT ALL INFORMATION PROVIDE ON THIS APPLICATION IS ACCURATE TO THE BEST OF MY KNOWLEDGE.

I HAVE READ AND UNDERSTAND THE CAMP RULES AND REGULATIONS AND ALSO UNDERSTAND THAT BY SIGNING THIS APPLICATION I/REGISTRANT AM AGREEING TO ABIDE BY THOSE RULES. I UNDERSTAND THAT FAILURE TO DO SO COULD RESULT IN DISMISSAL FROM CAMP. ANY CONDUCT INCOMPATIBLE, INCONSISTENT, OR CONFLICTING WITH THE MISSION OF CAMP KAHOKA AS A CHRISTIAN CAMP WILL CONSTITUTE REASON OR CAUSE FOR DISMISSAL FROM CAMP AND/OR THE DECISION TO REFUSE ACCEPTANCE TO FUTURE CAMPS. I ALSO AGREE THAT THE CHURCH OF GOD OF PROPHECY (LOCAL, REGIONAL, AND INTERNATIONAL OFFICES) AND ITS OFFICERS, SERVANTS, AND STAFF SHALL NOT BE HELD RESPONSIBLE FOR DAMAGES FOR ANY ACCIDENT OR SICKENESS INVOLVING MY CHILD.

I HEREBY AGREE THAT I/MY CHILD/WARD MAY PARTICIPATE IN ALL CAMP ACTIVITIES INCLUDING TRAVEL OFF THE PROPERTY.
 
I GIVE MY PERMISSION OF CAMP KAHOKA ADMINISTRATION TO USE IMAGES AND RECORDINGS OF MY CHILD/WARD/MYSELF (INCLUDING SOCIAL MEDIA OR WEBSITE USE) WITHOUT FURTHER COMPENATATION.
 
I ALSO AGREE TO HOLD HARMLESS CAMP KAHOKA, ITS STAFF AND VOLUNTEERS FROM ANY AND ALL LIABILITIES, CLAIMS, DEMANDS, AND CAUSES OF ACTION WHATSOEVER, WHICH MAY ARISE DUE TO THE PARTICIPATION OF MYSELF, OR MY CHILD/WARD IN SAID ACTIVITIES.  
 
I ACKNOWLEDGE THAT TYPING MY NAME BELOW AND COMPLETING THIS REGISTRATION FORM,  I AM ELECTRONICALLY SIGNING THE DOCUMENT, WHICH WILL HAVE THE SAME LEGAL EFFECT AS THE EXECUTION OF THE DOCUMENT BY A WRITTEN SIGNATURE AND SHALL BE VALID EVIDENCE OF MY INTENT AND AGREEMENT TO BE BOUND. PARENT OR GUARDIANMUST SIGN IF UNDER 18