Elementary Camp July 11th - 17th, 2021
This camp session is designed for young children in Grades 4th - 6th ("Grade" is defined as the grade to be entered next).
CAMPER'S PERSONAL INFORMATION
Last Name: *
First Name: *
Date of Birth *
Age of Camper while attending Camp *
Is this Camper's first time attending YBC? *
Address: *
City: *
State: *
Zip Code *
Parent's Last Name(s) *
Parent's First Name(s): *
Primary Day Time Phone Number (Include Area Code) *
Secondary or Evening Phone Number (Include Area Code)
Parent's Email Address: *
EMERGENCY CONTACT INFORMATION
Emergency Contact Person(s) (include first & last names) *
Relationship to Camper *
Address *
City *
State *
Zip Code *
Primary Phone Number (Include Area Code) *
Work Phone Number (Include Area Code) *
Family Physician *
Physician's Contact Number *
Health/Accident Insurance Company's Name *
Policy Number *
CAMPER'S HEALTH/MEDICAL INFORMATION
Addendum: To Parents/Guardians: Please print off this form (both sides) if not accompanying camper to a youth camp.
All medications brought by the camper will be administered by a nurse or doctor under the directions of the camper’s regular doctor. Any otc (over-the-counter) medications that might be needed at camp will discussed at sign-in. If you cannot be present a phone call will need to be done.
Any medication sent to the camp must be in its original container. Please print instructions on a 3x5” card and place with the medication in a zip-lock bag.
Electronic Signatures -For the safety and well-being of the youth, an applicant will not be permitted to attend until this form is fully completed and signed by the camper’s parent/guardian. To register on arrival without a parent, you must bring this form, fully completed and signed by parent or guardian (THIS INCLUDES TEENS ALSO). Please provide your electronic signature below; *
Today's Date *
MM
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DD
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YYYY
Please list all medications brought to YBC to be taken while at camp *
Please list all medications taken in the thirty days prior to arrival at Yellowstone Bible Camp *
CAMPER'S HEALTH HISTORY
Date of most recent examination *
MM
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DD
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YYYY
Immunization History
(Please give dates for all that apply)
DPT Series
Booster
Chicken Pox
Hepatitis A
Hepatitis B
Measles
Meningitis
Mumps
Polio
Rubella
Tetanus
Tuberculin Test Result
ALLERGIES
Please check all that apply *
Required
HEALTH CONCERNS
Please check all that apply *
Required
Please explain any checked item above (If none put N/A) *
Chronic Illness or serious illness in last six months *
If not applicable please put N/A
List of any special equipment needed(e.g. Wheelchair, Brace, Glasses, Other *
If not applicable please put N/A
Recent operations or serious injuries: *
If not applicable please put N/A
Restrictions or limitations while at camp: *
If not applicable please put N/A
Parental and Child Statements
To the best of my knowledge this information is accurate and complete. I give my permission for my child to participate fully in YBC activities, subject to limits described herein. In the event of accident or illness in the course of such activity I request that measures be taken without delay as judgment of medical personnel dictates. YBC will not be held responsible for bodily injury, death, or loss of personal property, except to the extent due to the negligence of YBC. I have read, understand, and accept the terms and conditions stated herein and acknowledge that this agreement shall be effective and binding upon the parties during the entire period of attendance at YBC. In case of evacuation due to natural disaster, I agree to immediately pick up (or make arrangements for the pickup of) my child/children at the Livingston church of Christ building or other stated location when notified to do so.
My child and I have fully read the Standards of Conduct located in the YBC Newsletter or YBC web-site, and he/she will comply with all standards. In addition my signature agrees and grants full right to use the images resulting from the photography/video filming, and any reproductions or adaptations of the images for fundraising, publicity or other purposes to help achieve the aims of Yellowstone Bible Camp. This might inclue (but is not limited to), the right to use them in their printed and online pubilicity or social media, press releases and funding applicaitons.
Electronic Signatures
For the safety and well-being of the youth, an applicant will not be permitted to attend until this form is fully completed and signed by the camper’s parent/guardian. To register on arrival without a parent, you must bring this form, fully completed and signed by parent or guardian. THIS INCLUDES TEENS ALSO.
Parent/Guardian *
Camper *
Today's Date *
MM
/
DD
/
YYYY
Yellowstone Bible Camp does not discriminate as to color, creed, or nationality in accepting applications.
Thanks for choosing Yellowstone Bible Camp!
After you hit the submit button below you will have completed Step-1 and will be taken to a page where you will complete Step-2. To avoid double entries only click the Submit button one time and do not use your browser buttons for any reason. Step-2 includes checking out and paying for your reservation. If for any reason you do not complete Step-2 your registration will be discarded and you will be required to start the process from the beginning by filling out the application again. Thanks for choosing Yellowstone Bible Camp!
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