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Ascension Middle School Camp Form

Please complete the form below. Required fields marked with an asterisk *

Ascension Middle School Leadership Camp

September 2-4, 2026

Camp Lakewood - Potosi, Missouri

Participants: All 6th, 7th, and 8th Graders

Departure: Wednesday, September 2 @ 8:00am (after normal drop off)

Return: Friday, September 4 @ 3:00pm (before normal dismissal)

Cost: $300 per camper

Basic Information

● Students will participate in a 3-day, 2-night camp at Camp Lakewood in Potosi, Missouri (Camp Lakewood). The facility is a Christian outdoor education facility located in the Eastern Ozarks

● There will be an 8-to-1 student to adult chaperone ratio.

● Boys and girls will sleep in single gender cabins on the property.

○ Campers sleep grouped by gender and grade level.

○ Chaperones sleep in cabins with students.

● Activities include hiking, archery, a ropes course, and much more!

● Students will travel by chartered bus.

Health and Safety

● STUDENTS ARE NOT ALLOWED TO SELF MEDICATE. Please complete the authorization for medication administration form for any child who receives medicines and prescriptions on a regular basis (form included below). This includes prescriptions that are regularly given at home but not at school, including Tylenol or ibuprofen for aches and pains.

● Our school nurse, Gretchen Kirsch, will attend the trip to manage the distribution of medications.

● Complete the attached form (below) to permit the distribution of as-needed medications such as Tylenol and return with the pediatrician's signature along with yours.

● All allergies and food restrictions will be communicated to the camp and accommodated at mealtime.

Payment

● Payment and forms are due on or before Friday August 21st at 3 pm.

● All payments should be made digitally below.

● Please contact Mrs. Fullmer if the $300 is prohibitive for your family.

Camp Rules

● NO CELL PHONES or ELECTRONICS ARE ALLOWED. The camp does not permit them nor will students be allowed to use them on the bus. If a student brings a phone or device, it will be confiscated and returned to parents when we arrive back from camp.

● Parents will be provided contact information for use in case of emergency.

● NO OUTSIDE FOOD IS ALLOWED

Additional Information

● Students should be dropped off with their belongings at the front of the school during normal drop off time. PLEASE DO NOT USE THE BACK ENTRANCE.

● If you need to contact someone at camp, please feel free to call one of the numbers below:

○ Mrs. Kelley Fullmer - 636-532-1151 ext. 3400

○ Dr. Leigh Ann Parker - 636-532-1151 ext. 3000

**Our desk phones will ring to our cell phones.

○ Camp Lakewood - 573-438-2155

13528 State Highway AA

Potosi, MO 63664

● We will return to school on Friday for "normal" dismissal procedures.

● Packing List is attached here.

Permission Form

Dear Parent or Legal Guardian,

Your child is eligible to participate in a school-sponsored activity requiring transportation to a location away from school. This activity will take place under the supervision and guidance of employees from Ascension School. A brief description of the activity follows:

Name of Event: Ascension Middle School Leadership Camp

Date: September 2-4, 2026

Destination: Camp Lakewood, Potosi, Missouri

Designated Supervisor(s): Mrs. Fullmer, Dr. Parker, Ascension staff, and parents

Time of Departure: 8:00 am, September 2, 2026

Time of Return: 3:00 pm, September 4, 2026

Method of transportation: Mid-American Coach

Student dress: See Packing List

Student cost: $300.00

If you would like your child to participate in this event, please complete, sign and submit the following statement of consent and release of liability. As parent or legal guardian, you remain fully responsible for any legal responsibility which may result from any personal actions taken by the named student.

Student Name:*

Answer required for "Student Name:"

Student Grade & Homeroom:*

Answer required for "Student Grade & Homeroom:"

I hereby consent to participation by my child (named above)in the event described above. I understand that this event will take place away from the school grounds and that my child will be under the supervision of the designated school employees on that stated date. I further consent to the conditions stated above on participation in this event, including method of transportation. *

Answer required for "I hereby consent to participation by my child (named above)in the event described above. I understand that this event will take place away from the school grounds and that my child will be under the supervision of the designated school employees on that stated date. I further consent to the conditions stated above on participation in this event, including method of transportation. "

Yes

In case of emergency, please list 2 emergency contact names & phone numbers below.

Emergency Contact 1 Name & Phone Number:*

Answer required for "Emergency Contact 1 Name & Phone Number:"

Emergency Contact 2 Name & Phone Number:*

Answer required for "Emergency Contact 2 Name & Phone Number:"

Consent for As-Needed PRN Medication

If you would like your child to be able to receive ANY kind of medication while at camp, you will need to print and complete out the Consent for As-Needed (PRN) Medication form and the Authorization for Medication Administration form. This form needs to be signed by a physician and returned to the front office or nurse's office before the students leave for camp.

YMCA Risk & Liability Form

ALL students attending camp need to have the YMCA Risk & Liability Form printed, signed, and returned to the front office before the students leave for camp.

Quantity

Camp Payment*

Price: $300.00

Please sign below to confirm permission for your child to attend camp:*

Signature Required

Confirmation Email

Confirmation Email *

Answer required for "Confirmation Email"