At DCCYC students will experi-ence authentic wor-ship and relevant bibli-cal teaching for the everyday adventure of following Jesus who alone deserves all that is us.

Additional focus work-shops make learning truly interactive:

Prayer: talking to God vs. talking to self.

Marriage & Dating: not to be worshipped.

Fame, money & success: serving the Giver with your God-given strengths.

Community: more than pizza and feelings.

Gospel: Jesus sets us free.

Family: loving the way God loves.

Media & Culture: turn-ing creativity into worship.

Authentic worship: seeing God for whom He claims to be.

In addition to these learning experiences, they will enjoy fun fellowship and rec-reational games and creative activities. They will experience teamwork and com-

munity as they engage and interact with other stu-dents and adult counselors.

JUNIOR HIGH: BO DUSTER

Originally from South Korea, Pete hails from the suburbs outside of Washing-ton, D.C. He moved to Vancou-ver in the summer of 2008 to attend Regent College and start ministry with youth at Surrey Presbyterian Church. He had

the privilege of marrying his lovely wife Chris-tina in May 2009 and welcoming two boys, Ma-son and then Connor into the world. He now serves as the youth pastor of Korean Central Presbyterian Church of Houston, where he began in April 2013.

Pete’s passions are both vast and intense — being an authentic Christian for Jesus in today’s world by living the life Jesus gives, loving his

wife Christina and his sons, cheering sports of all kinds (both as a participant and as a fan), especially basket-ball and football, especially the Dallas Cowboys, FOOD (finding, eating, creating and sharing), and good music (old school R&B, Jason Mraz, Shane and Shane, GOOD hip-hop).

Tim was born in Cali-fornia but raised in Dallas, Texas. He re-ceived his bachelor’s degree from Ouachita Baptist University and earned a Masters of Divinity from South-western Baptist Theo-

logical Seminary in Ft. Worth.

Tim has had the privilege of working with students and their families now for 14 years, and he's never wanted to do anything else. As the Lead Student Pastor for Fellowship Bible Church (Little Rock, AR), it is Tim's passion and goal to see all of our students and leaders equipped and unleashed in Jesus Name! His greatest blessings from the Lord are his high school sweetheart, Stephanie, and their three children. If he's not at church, he is probably with his family riding bikes, wrestling, playing music, hiking or getting together with other families.

Do-it-Now! Early bird registration

ends May 4

{ahy-dol-uh-tree}

You shall have no other gods before Me.

- Exodus 20:3

$280

RETURN your filled forms & your CHECK (payable to DCCYC) to your youth leader. DO NOT send your check to Lakeview Baptist Assembly.

What to Bring to Camp:

● Bible ● Friends ● Sleeping Bag ● Toiletries ● Towels ● Clothes ● Swim/Sports wear ● Sunscreen & Insect repellant ● Notebooks ● Pen/pencil ● Flash light ● Alarm clock ● Medicine if needed ● Money for snacks/souvenirs ● Light jacket ● Both medical forms

What Not to Bring to Camp:

Tobacco, Drugs, Alcohol, and Weapons — If found, local authorities will be contacted.

MP3 players, CD player, video games, video players, iPod, iTouch, iPhone, SmartPhones, Laptop, etc.

Due to fire ant problems, Lakeview Baptist Assembly does not allow any food in the cabins. Please leave all snacks at home. We will inspect cabins and take away food.

Dress Code: To avoid causing unnecessary temptation and

distraction, please dress appropriately for a Christian camp. That means wearing shorts that are an inch longer than your fingertips, and wearing shorts & pants that are at waist level versus below the waist. All shirts must overlap the waist and not be too tight fitting. Exposed midriffs will not be allowed. NO SLEEVELESS SHIRTS are permitted, unless they are covered by a shirt. Swim wear for guys are boxers style swim trunks and for gals are lined or non-translucent one-piece swim wear; no bikinis. If you are wearing something inappropriate, counselors will ask you to change into something more appropriate.

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Personal Information: Please fill in this form fully and legibly (please print). Also attach Lakeview Baptist Assembly Medical Au-thorization Form & DCCYC Medical Release Form.

Full name: ______________________________ M F

Grade in Fall 2014: ____ D.O.B. ___/___/_____ (mm/dd/yy)

Address: __________________________________________

City: ___________________ State: ________ Zip: ________

E-mail: ___________________________________________

Parents: ____________________ Phone: (____)____-______

Home church: _____________________________________

Your departure location: ACC CCCFC NLGC

No / Yes: [S M L XL]

My Christian Walk I have trusted Jesus as my Savior [Yes / No] I attend church regularly [Yes / No] I have been baptized [Yes / No] If No, I’m thinking about getting baptized [Yes / No] How often do you pray? Never 1 2 3 4 5 Always How often do you have devotionals? 1 2 3 4 5 How is your spiritual walk? (5 being best)1 2 3 4 5 I currently serve at church [Yes / No] If No, I would like to serve in the area of ___________

Camp Discipline: 2 strikes policy For example, if a camper fails to stay in his/her assigned cabin between 11:30 pm — 7:00 am, then: (1) 1st offense: $100 fine and parents will be notified immediately. (2) 2nd offense: (or on the last day of camp) $200 fine and parents will be called to take camper home. Campers will not be allowed to return to future camps unless fines are paid.

My Commitment to Honor God at Camp:

In submitting this DCCYC summer camp registration, I am agree-ing to abide by the rules and regulations set by DCCYC Camp Board and Lakeview Baptist Assembly. I accept the penalties/fees and discipline that come as consequences of failing to follow the rules.

Youth Sign ____________________ Date: __________

Parent Sign ____________________ Date: __________

REGISTRATION FEE ░ REFUND AND DEADLINES ░ POLICY

BY MAY 4th $ 280 BY MAY 4th FULL

BY JUNE 8th

HALF

AFTER JUNE 8th

NO REFUND

Lakeview Baptist Assembly is located at: 240 Camp Circle

Lone Star, TX 75668

Come to Lone Star via HWY 259. Go to “Lone Star Baptist Church” sign, turn west on Williamsburg Street,

go 3 blocks to Stop sign. Go straight ahead, through Lone Star Baptist Church parking lot. Lakeview is

located behind Lone Star Baptist Church.

CHARTER BUS INFO:

Departure: June 18th Arlington Chinese Church: 8:00AM

New Life Gospel Church: 8:30AM

Collin County Chinese Fellowship Church: 9:00AM

Returning: June 22rd Arlington Chinese Church: 6:00PM

New Life Gospel Church: 5:30AM

Collin County Chinese Fellowship Church: 5:00PM

(Please remember to bring a sack lunch for bus ride on June 18)

$ 305

$ 330

BY JUNE 1st

AFTER JUNE 1st

MEDICAL RELEASE FORM

Dallas Chinese Christian Youth Camp

As the parent/legal guardian of (Name of Student):

I hereby give my permission for my child to participate in the 2014 Dallas Chinese Christian Youth Camp or “DCCYC

2014”, June 18-22, or any of DCCYC’s activities. I hereby release DCCYC, its staff, sponsors and officers from liability for

any illness, injury, misadventure, or harm of any kind suffered as a result of participation in “DCCYC 2014”.

I request that in my absence the above-named student be admitted to any hospital or medical facility for diagnosis and

treatment. I request and authorize physicians, dentists, and staff, duly licensed as Doctors of Medicine or Doctors of

Dentistry or other such licensed technicians or nurses, to perform any diagnostic procedures, treatment procedures, operative

procedures and x-ray treatment of the above minor. I have not been given a guarantee as to the results of examination or

treatment. I authorize the hospital or medical facility to dispose of any specimen or tissue taken from the above-named

student.

Date of student’s birth: / / Date of last Tetanus Booster: / / Allergies:

Other Medical Conditions:

Student’s Physician: Phone #: ( ) -

( ) -

Medical Insurance Co. Phone #:

Policy Holder Policy Number

Name of Parent/Guardian:

Street Address:

City:

State:

Zip

Phone # H:

( ) -

Phone # M:

( ) -

Work #:

( ) -

Person to notify if parent/guardian is unavailable:

Street Address:

City:

State:

Zip

Phone # H:

( ) -

Phone # M:

( ) -

Work #:

( ) -

Signature of Parent /Guardian: Date:

\

DCCYC REVISED 04/14

Lakeview Baptist Assembly Medication Camps-Conferences-Retreats Release/Administration Form

Lakeview requires that all sponsors/campers who need medication during their attendance at camp must do the following:

1. Complete and present the consent below, signed by parent or legal guardian for administration of

medication while the student attends camp at Lakeview. 2. Bring the medication IN THE ORIGINAL BOTTLE (prescription or over-the-counter), properly

labeled as prescribed by law. 3. Present this form and the medication indicated on this form to the nurse upon arrival on campus and

abide by his/her instructions for administration. 4. If more than one medication is to be administered, a separate form is to be completed and signed for

each medication.

Medication Information for:

Name: __________________________________________ Birth date: ___________________________ Sex: _____M _____F (Month/Day/Year)

Church group student came with _________________________________________________________________________________ (Church Name) (Church City & State)

Name of medication ___________________________________________________________________________________________

Purpose for medication use (e.g. allergies, asthma, antibiotic) __________________________________________________________

Form of medication: ____Tablet ____Pill ____Capsule ____Liquid ____Inhalation

____Other (specify) _______________________________________

Dosage (amount to be given): ____________________________ How often or at what time: ________________________________

Remarks or special instructions: _________________________________________________________________________________

As the parent or legal guardian of the above child, I hereby give permission for the camp nurse or administration to administer this medication to my child.

___________________________ ( ) - ( ) - ___________ Parent/Guardian signature Daytime Phone # (include area code) Evening Phone # (include area code) Date ________________________________________________________________________________________________________________________________

FOR OFFICE USE ONLY ________________________________________________________________________________________________________________________________

Please indicate at the left, time and your initials Day Date Time Given/ Person Administering

each time medication is administered. Each person

Dose 1 Dose 2 Dose 3 Dose 4 administering medication should indicate full

Sunday name and title in space below.

Monday

Tuesday Initial _________= Name______________________

Wednesday Initial _________= Name______________________

Thursday Initial _________= Name______________________

Friday Initial _________= Name______________________

Saturday Notes or comments: ___________________________________________________________________________

____________________________________________________________________________________________

Lakeview Baptist Assembly P. O. Box 0130 – Lone Star, Texas – Phone 903-656-3871

Medical Information/Consent/Agreement to Participate Church/Organization: _____________________

Participant’s Last Name: _____________________ First Name: _____________________ Date of Birth: ______ Age: ____ Sex: ___

Address: _______________________________________________________________ Social Security Number: ________________ (Number & Street) (City & Zip Code)

Parent/Guardian: __________________________ Address: __________________________________ Relationship: ______________ (If different than participant’s) Daytime Phone: __________________________ Cell Phone: ______________________ Pager ______________________________

Emergency Notification

Name: _______________________________________ Relationship: ____________________ Daytime Phone: _________________

Evening Phone: ____________________ Cell Phone: _________________________ Pager: ________________________

Medical Dr. Name: ____________________ Phone: _____________ Dentist Name: _____________________ Phone: ____________

Insurance Company: ____________________________ Name of Insured: ___________________________ Policy # _____________ Insurance Address: _________________________________________________ Phone Number: ____________________________

Sponsor allowed authorizing emergency care in lieu of Parent/Guardian: _________________________________________________

Person permitted to take Participant from camp: ________________________________________ Grade Completed: ___________ Please include any other information you think we need to know on an extra sheet of paper.

Medical Information

Allergies (List and Explain Reaction): ____________________________________________________________________________

Check any conditions: Diabetes __ Epilepsy __ Asthma __ Heart __ Chest Pain __Thyroid __ Kidney __ Dizziness __ Back pain__

Broken Bones __ Bleeding Disorders __ Operations __ High Blood Pressure __ Any Other Conditions _______________________

Explanation of the above: _____________________________________________List Any dietary or Physical Restrictions on back:

Are all immunizations current: Yes ___ No ___ Date of Last Tetanus Shot: _______

List Medications currently being taken: ___________________________________________________________________________

I/we hereby authorize the camp nurse or camp director to administer all medication brought by participant. If a medical emergency should arise while the above listed camper is in attendance at Lakeview Baptist Assembly, I/we hereby authorize the camp nurse or camp director to provide care to the camper and/or transport the camper to a medical facility. I/we further authorize the health care provider of the medical facility to administer necessary medical and/or surgical care upon arrival at the medical facility. I/we understand that camp officials will make a conscientious effort to locate the parent/guardian or the emergency contact listed on this document before any action will be taken. If it is not possible to locate the emergency contact listed, I/we will accept the expense of emergency medical and/or surgical treatment. I/we give my authority and consent for Lakeview Baptist Assembly or camp nurse to treat my child for minor injuries and illnesses with the appropriate non-prescription medication.

AGREEMENT TO PARTICIPATE: ASSUMPTION OF RISK AND RELEASE OF LIABILITY WHEREAS, THE UNDERSIGNED (“the PARTICIPANT”) wishes to be accepted for participation in all activities conducted by LAKEVIEW BAPTIST ASSEMBLY & CONFERENCE CENTER, INC. In consideration of, and for the right to participate in such an activity by LAKEVIEW BAPTIST ASSEMBLY & CONFERENCE CENTER, INC., its Directors, Officers, Trustees, Employees, Agents, and/or Associates, I/we have and do hereby assume all of the risks and any other ordinary risk incidental to the nature of the activity. Further, I/we will hold them harmless from any and all liability, actions, causes of action, debts, claims, and demands of every kind and nature whatsoever, whether for bodily injury, property damage or loss, medical bills, hospital bills, and doctor bills, or other wise, which the participant now has or which may arise from or in connection with participation in any other activities arranged for me by LAKEVIEW BAPTIST ASSEMBLY & CONFERENCE CENTER, INC., its Directors, Officers, Trustees, Employees, Agents, and/or Associates, and their heirs, executors, and administrators, successors and assigns and for all members of my family, including any minors accompanying me. I/we fully understand that my physical activity involves risk of injury. I/we also understand that my participation in any activity is entirely VOLUNTARY. I/we enter into this activity and take full responsibility for the decision to participate or not to participate and agree to follow all safety instructions.

AGREEMENT TO HAVE PHOTOGRAPH TAKEN: I/we are aware of the fact that photos of my child or of myself may be taken during the week by camp staff, which may appear in future camp publicity. By signing this, I/we give permission to use these photos, aware of the fact that my child or myself WILL NOT be identified by name in any such photos. I/we hereby give permission to have my photograph taken. If this is unacceptable, I/we will so state that fact here by writing “NO” in the space provided. _________

_____________________________________ _________________________ Signature of parent/guardian (if participant under age 18) Date of Signature

_____________________________________ _________________________ Signature of participant Date of Signature

FOR ADULT SPONSORS ONLY (What is your responsibility while attending camp?) ______________________________ Pastor/Staff Recommendation: I recommend this adult to be a responsible sponsor. (sponsor, camp director, recreational team) __________________________________________________________________________

Pastor/Staff Signature