Individual form must be submitted for each registrant and registration fee must be paid in full by June 28th.

430 Sheep Pasture Road, Port Jefferson, NY 11777

Telephone: 631-473-0894 + Fax: 631-928-5131 + Email:  goc.assumption@gmail.com

Session: Monday, July 8 to Friday, July 12, 2024 - 9am to 2:30pm

Registration: $125 per child - Ages 4 to 12

Child's Name
Is camper attending full session? *

We may communicate via email or text so please check often for our correspondences. We may also send info via backpacks.

Please make checks payable to GOCOA

The registration fee is non-transferable, non-refundable and non-negotiable. Fee will not be prorated.

Medical Consent

I hereby certify that my child is in good health and physical condition and has no medical condition that may impeded his or her ability to participate in church camp activities. I also hereby given the right to camp officials to institute or administer emergency treatment such as first aid, physician, dentist, ambulance, hospital, etc. for my child should the need arise. I do not hold the Greek orthodox Church of the Assumption responsible for any accidents or illnesses incurred. If I provide medication, I authorize the camp to dispense it. I authorize administration/dispension of any provided emergency allergy medications at the camp official’s discretion. All medications will be accompanied by a note from my child’s doctor to the camp with the written protocol for such medications. 
Parent's Signature *


  1. We are a strict nut-free camp. This includes all nuts, nut and “Nutella” spreads, yogurts with nut toppings, certain breakfast bars, almond and nut milks, etc. Please read labels carefully.
  2. No smoking, vaping, alcoholic beverages, recreational or other drugs or substances will be tolerated by anyone.
  3. No touching, hitting, or inappropriate language is to be directed to fellow campers or others. Campers will show respect and courtesy to staff and fellow campers.
  4. If you send lunch and snack in, please put it in separate bags and label each accordingly.
  5. Campers should arrive promptly with sunscreen already applied and bug spray if desired.
  6. Campers will stay on church grounds, except to attend camp-sponsored field trips.
  7. Young enrolled children must be capable of independently using the lavatory.
  8. Appropriate dress is required and consists of mandatory camp t-shirt, and modest length shorts, skirts or dresses, socks and closed sneakers or shoes.
  9. Campers are to be picked up and dropped off promptly.
  10. All children and counselors must be signed in as being present daily.
  11. Cell phones and other electronic devices may not be used during camp and are subject to being forfeited for non-compliance.
  12. The Church will not be responsible for any lost or damaged personal items.
  13. Notify church if camper will be absent for the day.
  14. Children will not be released at day’s end until they are signed out by the parent/guardian listed on this form.
  15. Parents must wait in the community center lobby for their child to be released.
  16. If someone else is picking you your child, please notify us in writing and by phone.
A camper may be dismissed from camp if there is any infraction of these Rules, Regulations, and Conduct, and all remaining camp fees shall be forfeited


I, (Parent's name listed above) am the parent/legal guardian of, and certify that, (Name of child listed above), is able to participate in all activities of camp. I grant my child permission to participate in any off-premises field trips and grant that my child be transported via car or bus. I understand my child will not be admitted to camp until the medical consent and registration form is signed, dated and completed in entirety. I and my child have read and understand all the camp rules and regulations and will abide by all. We release the Church/Camp of all liability. I hereby agree to indemnify, hold harmless and expressly release the Camp, GOC of the Assumption, and all personnel involved in Camp from any and all negligence, causes of actions, claims, suits, costs, injuries, and damages of every name and description related to my child’s participation in the camp. I understand that on days when Camp provides meals either on premises or field trips, if I do not wish my child to participate, I will notify the camp and provide my child with lunch and snack.  Camp is not liable for damages or illnesses by any food consumption whether brought in by campers or provided on premises or off. By also signing this form we agree to allow our child to be photographed which may be used but not limited to Church/Camp private Facebook or other social media pages as well as other Church materials.  I also certify I and my child will abide by any additional rules specified either orally or written during the duration of GOCOA summer camp. My signature is binding and representative of any other guardianship/parent of the named child.

Parent's Signature *
Camp Shirts: Please select size desired: One Shirt per camper will be provided with enrollment. Additional shirts are available at an extra cost. *
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