2020 Camp Connexion Youth/Worker Registration
Camp is June 1-4, 2020.
What is your name?
Please choose one:
I am a youth worker at Camp Connexion.
I am an adult Bible Study Leader at Camp Connexion
I am an adult Track Leader at Camp Connexion
I am an adult Cabin Counselor Leader at Camp Connexion
I am an adult worker at Camp Connexion
What shirt size will you need? T-shirts are $10.
I do not want a shirt
What church do you attend?
Alton Church of God
Brewer Lake Baptist
Mayo Church of Christ
What is your birthday? (mo/day/yr)
What is your email?
What is your address?
Please list your Insurance Information with Group and Policy Number.
IF YOUTH: Please list Parent Names with Phone Numbers
Please list any other contact names with relationship and phone numbers if there is an emergency.
Please list any allergies you have.
Please explain any special needs or any medical issues the camp staff/nurse should be made aware of.
I agree that photographs or videos may be taken of me and used in promotional materials.
I grant my permission for the Camp Director, Assistant Director, or other staff person in charge to obtain necessary medical treatment in case of sickness or injury to the camper named above. I do hereby release and forever discharge all sponsors, Middle Florida Baptist Assembly, Inc. (Camp Pickett Lake), and Camp Connexion from any and all claims, demands, actions or cause of action, past, present, or future, arising out of any damage or injury while employed or participating in Camp Connexion during May 31-June 4, 2020. I hereby also agree to assume obligation for any necessary expense not covered by Middle Florida Baptist Assembly, Inc. insurance policy for the camper named above.
I agree and will submit the form as my sign of agreeance.
If you do not agree to the terms, please exit without submitting and know that we can not accept registrations that do not agree to these terms.
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This form was created inside of Lafayette School District.