Limitless Children's Camp Registration
Fill out this form completely to reserve your spot for summer camp.
Church Name *
Your answer
Parent's Name/Chaperone's Name *
Your answer
Home Address *
Your answer
Phone Number *
Your answer
I am over the age of 18, and will be attended camp as a chaperone. I also agree to provide a Background check ($12), contact Jeremy Stone 270-316-0203 for more details.
Camper *
Student's Name (Chaperones can just type "Chaperone") *
Your answer
Grade Level Entering *
What grade will they be in Fall 2018
Gender *
Activities Track Time Choices *
Please rank the 6 Activities in the order of preference ( 1 - Favorite, 6 - Least Favorite). Each camper will be assigned to Activities for the week based on availability.
1 - Favorite
2 - Second Favorite
3 - I would be ok with this
4 - Not cool
5 - Please don't
6 - Not gonna do it!
Drama/Theme Interp
Bass Fishing
Can the camper swim? *
Any Allergies, Asthma, or Other Medical Conditions
Other Important Health Information the Camp Staff may need to know:
Your answer
Physician's Name *
Your answer
Physician's Contact Number *
Your answer
Name of Primary Insurance Policy Holder *
Your answer
Name Insurance Provider *
Your answer
Insurance Policy Number *
You will be required to send a copy of the insurance card with your chaperone.
Your answer
In consideration for your agreeing to accept the above individual as a camper, I hereby give my authority and consent for any first aid treatment as may be needed in the judgment of Schafer Baptist Camp Administration. In the case of an emergency, medical or surgical treatment can be given by physicians, nurses, etc. selected by Camp Director to hospitalize, secure proper treatment for, and to order injections, anesthesia or surgery for the above named child. I understand that limited secondary accident and illness coverage is provided. I, also, release the Daviess McLean Baptist Association, camp directors, camp pastors, camp counselors, and Camp Schafer staff from any liability or responsibility for accidents or incidents during camp. I understand I will be contacted in the case of an emergency. In the event I can not be contacted in an emergency camp personal may contact the Emergency Contact Listed Below. *
Emergency Contact Name and Phone Number *
Your answer
I give my permission for my child's picture to used in Schafer Camp promotion material. *
T-Shirt Size *
Please send your reservations along with the $100.00 non-refundable registration fee (Per CHURCH) to: Jeremy Stone, 8175 Old Highway 54 Philpot, KY 42366. The $100 will be deducted from your total cost the day of camp registration. All checks should be made out to Daviess McLean Baptist Association. This online form is all you need to turn in to be registered. *
Reservations Due by June 15, 2018
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