Register your child for Corning Area Bible Club Camp 2021

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Junior and Teen Camp: August 9th-14th

Email *

Camper first & last name *

Camper age *

Camper sex *

Male

Female

Camper address *

Grade camper completed in 2021 *

Cabin mate request (up to 2 names) Requests can not be guaranteed. *

Phone number *

Please list any allergies *

T Shirt Size- Must register by July 10th to get a T Shirt. *

Youth Small

Youth Medium

Youth Large

Adult Small

Adult Medium

Adult Large

Adult XL

Other:

I agree to allow BCM International/Corning Area Bible Club to use audio, video, and still pictures of my child for promotional purposes. My child’s name will not be used. By answering yes, I consent to these statements and grant such authorizations. *

Yes

Camp total cost is $275 for the week ($25 non-refundable deposit, $250 camp fee) Please select a payment option below. Checks should be written to "Corning Area Bible Club" and mailed to 17 Goss Rd. Elmira, NY 14903 *

Pay in full now (if paid by May 1st, $25 discount is given, total would be $250)

Pay $25 registration fee now by mail, pay balance due at camp

Pay $25 registration fee now, mail balance due prior to camp

Emergency contact name *

Emergency contact phone number *

MEDICAL RELEASE: READ AND INITIAL BELOW: The undersigned, intending to be bound hereby, realizing it is the camp's desire to give each camper a safe and beneficial stay, and realizing each camper is covered by a reputable insurance plan, releases Corning Area Bible Club Camp and all individuals associated therewith, for any and all liability for an injury or damage which may be sustained by the undersigned and/or child of or property of the same at or in transit to or from Corning Bible Club Camp activity or under the auspices of the Corning Bible Club Camp. By initialing below, I hereby authorize care in the case of an emergency. I also give permissions to the selected physician to hospitalize, secure proper treatment for, and to order injection or surgery for my child as named above. *

A copy of your responses will be emailed to the address you provided.

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