5 Star Bible Camp 2017 Camper Registration Form
5 STAR BIBLE CAMP 2017
July 16—July 23, 2017
CAMP JEFFERSON
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
Your answer
Camper's Name - First
Your answer
Age
Date of Birth
MM
/
DD
/
YYYY
Male or Female
Grade Completed by July, 2017
Address City, State Zip
Your answer
Phone Number (Cell)(Area Code)XXX-XXXX
Your answer
Day Phone (if different) (Area Code)XXX-XXXX
Your answer
Evening Phone (if different) (Area Code)XXX-XXXX
Your answer
Church Affiliation
Emergency Contact Name
Your answer
Relationship to Camper
Emergency Contact Phone (Area Code)XXX-XXXX
Your answer
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.
Your answer
PLEASE LIST ANY KNOWN ALLERGIES.
Your answer
PLEASE LIST SPECIAL ASSISTANCE OF ANY TYPE.
Your answer
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.
Required
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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