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   Mass Jesus Momentum #MJM


"Sweet Jambalaya" 

The summer reading and performing arts camp will share in a culminating performance of the stage play; "Sweet Jambalaya" through the  arts; acting, singing, dancing, and performance poetry. Will you join us? Admission is free!


Summer Camp Application






NAME _____________________________________________ AGE _____________________ CAMPER’S NAME _____________________________________________ AGE _____________________ CAMPER’S NAME _____________________________________________ AGE _____________________

Parent’s Name: _______________________________________________________________________ Address: _____________________________________________________________________________ City: ________________________________________ State: ___________ Zip: ____________________ Home Phone _____________________________ Work Phone: _________________________________ Cell Phone: ______________________________ Email Address__________________________ Registration Date: ________________________

The camp hours are 9 am to 3pm, Monday through Friday July 9th through July 20th with a performance on the 21st @ 2pm. The camp will be held at Oak Pointe Commuity Center. 730 E. Boudary St. Augusta GA 30901. 



AGAPE VILLAGE SUMMER READING AND PERFORMING ARTS CAMP is not responsible for camper’s personal belongings if lost, stolen or damaged.


 AVSRPAC will make every effort to provide proper Supervision so that losses will be at a minimum.


Directors reserve the right to deny, cancel, sever, or suspend a child’s enrollment if deemed in the best interest of the camper or AVSRPAC.


I realize every precaution is taken to eliminate any injuries or hazards, and a competent supervisor is present; however, in the event of an injury, I hereby waive, release and hold harmless from any liability for damages for personal injury including accidental death, as well as from claims for property damage which may arise in connection with the above named activity, against the director, ISRAPAC, its officers, agents, employees, and volunteers.


In case of an accident or other emergency, personnel of ISRAPAC   and/or its agents are hereby authorized to secure medical care if deemed necessary as a result of accident or injury of participant. I further agree to pay any and all costs incurred as a result of said treatment.


 PARENT/GUARDIAN SIGNATURE: __________________________________________________________ DATE ______________________


Important Information Form


Child’s Name: ________________________________________ Age: ________ Sex: _____ D.O.B.:________________

Parent or Guardian Name: ___________________________________________________________________________

 Phone Contact: Home/Cell: _____________________________________________________

 Work: __________________________ Email Address: ___________________________

In Case of Emergency:

Emergency Contact: ___________________________________________________________________ Number: ________________________

Alternate Contact: _____________________________________________________________________ Number: ________________________

Preferred health care facility: _____________________________________________________________________________________ (Nearest one if none preferred)

Family Doctor: _________________________________________________________________________ Number: ________________________ (Physician on staff if none entered) GENERAL HEALTH INFORMATION: Please list any and all medical conditions: _____________________________________________________________________________________ _____________________________________________________________________________________

Recent Medical Attention or Serious Injuries: _____________________________________________________________________________________ _____________________________________________________________________________________


 Restricted activities or physical limitations of camper: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Other Health-related information: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ If medication is to be administered at camp, please fill out Medical Form included. Behavioral or emotional information: _____________________________________________________________________________________ _____________________________________________________________________________________ Seasonal Allergies & Treatment: _____________________________________________________________________________________ _____________________________________________________________________________________Food Allergies & Treatment: _____________________________________________________________________________________ _____________________________________________________________________________________


                                                               HEALTH HISTORY STATEMENT

This health history is correct to the best of my knowledge, and the camper listed above has permission to engage in all camp activities without limitations except as noted.


EMERGENCY AUTHORIZATION: In the event I cannot be reached in an emergency, I hereby give my permission to the physician selected by the camp director to secure proper treatment for the person named above.


I authorize ______________________________________________________ camp to use photographs of my child in their advertising material. Yes / No


The following persons are authorized to pick up my child or children: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________  Signature: _________________________________________     Date: ___________________________



 CAMPER’S NAME________________________________________________________________

I authorize AVSRPAC  staff to administer the medication listed below as prescribed by my physician.

Parent/Guardian Name _____________________________________________________________ Parent/Guardian Signature __________________________________________________________ Name of Medication to be administered: _______________________________________________

 List the condition for which the medication is being used and any cautionary information specific to the medication: _____________________________________________________________________________________ _____________________________________________________________________________________ The instructions for administration, including the dosage and frequency of administration: _____________________________________________________________________________________ _____________________________________________________________________________________ List date, time and name of the person administering the medication to the camper: _____________________________________________________________________________________ _____________________________________________________________________________________ List any medication errors and any adverse drug reactions: _____________________________________________________________________________________ _____________________________________________________________________________________ The camp director shall inform the prescribing physician of any medication error or adverse drug reaction. The camp director shall return any unused medication to the camper’s parent or guardian within three working days after the camper’s last day. The camp director shall destroy any medication he or she is unable to return.

Evangelism by Tralyne DeShae

The creative juices are flowing
Inside me knowing
That this is an expression of Him
The true gem
I can take no credit
For this gift is not my own
But it came straight from the throne
From the bowels of the throne room of compassion
This limitlessness is matchless
None can compare
O contraire mon frere
Who would dare?
I am but an extension of Him
The true gem
Gem germinates the innate within
His next of kin
Stirring and contemplating
What part of him he will birth
Through poetry
Through dance

Through the arts
His best he imparts
To the unsuspecting
The suspect being
The ones without
Those that don’t shout
But shoot up
Caught in a rut
Wanting to die
Scared to try
To live
To these ones
He gives his gifts and talents
His abilities and possibilities
The drunk on the street
Is a philosophizing beast
Because the gift to reason is on the inside of Him
Inspite of Him
That thugged out pimp
God didn’t skimp
On the gift to sing
Everything is not about His diamond rings and bling bling
There’s an impartation in him
No less than them
Who cry Holy Holy on Sunday morning
These is the highways and hedges folks
That God calls us to invoke
Life in

That prostitute, homosexual, wife beating lunatic
Is your next of kin

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