5 Star Bible Camp 2017 Camper Registration Form
5 STAR BIBLE CAMP 2017
July 16—July 23, 2017
Hero Central - Finding Your Strength in God
ALL CHILDREN WELCOME!!!!
ELEMENTARY CAMP: (Overnight) Open to children who have completed 4th to 6th grades
Registration 7:00 pm Sunday, July 16th ending after the program - July 19th 6:00pm
DAY CAMP: Open to children 5 years old (by July 16th, 2016) - 3rd grade.
(4 year old children welcome with an attending parent/guardian)
July 17th - July 19th 1:00 PM to 6:00 PM Registration - Monday 12:30PM (No meal provided - Snack only)
YOUTH CAMP: (Overnight) Open to youth who have completed 7th-12th grades.
Registration 9 AM Thursday, July 20th - 12:00 pm July 23th
All Registrations due by June 30th.
Camper's Name - Last
Camper's Name - First
Date of Birth
Male or Female
Grade Completed by July, 2017
Address City, State Zip
Phone Number (Cell)(Area Code)XXX-XXXX
Day Phone (if different) (Area Code)XXX-XXXX
Evening Phone (if different) (Area Code)XXX-XXXX
Zion Countryside Church
St. Paul UCC
Emergency Contact Name
Relationship to Camper
Emergency Contact Phone (Area Code)XXX-XXXX
WHICH “OVER-THE-COUNTER” MEDICATIONS MAY THE CAMP NURSE DISPENSE TO YOUR CHILD IF DEEMED NECESSARY? (Tylenol, Ibuprofen, Benadryl, ointments, etc.) Please list. The nurse will have to call you for permission if this area is not marked and your child requires any medications.
PLEASE LIST ANY KNOWN ALLERGIES.
PLEASE LIST SPECIAL ASSISTANCE OF ANY TYPE.
PLEASE BRING A LIST OF MEDICATIONS TO BE DISPENSED AT CAMP.
In the event of illness or accident, if the parent or guardian cannot be reached, I authorize the 5 Star Bible Camp personnel to consent to any diagnosis, examination, treatment, or hospital care for my child which is deemed advisable by and is rendered under the supervision of a physician. I release the involved churches, Camp Jefferson and their agents from responsibility in the case of accident or illness in connection with any camp activities.
I give my permission for photographs and/or video to be taken of my child while engaged in camp activities and for these images to be used in the media, social media, or websites and in promotional materials of the camp.
T Shirt Size
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