2023 Registration Form
Please fill out completely.  Payment is due upon arrival at camp.
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Camper's First & Last Name *
Gender *
Age *
Grade Completed *
Street Address *
City *
State *
Zip *
Home Church *
Has the camper been immersed for the forgiveness of their sins? *
Week(s) of Camp Attending *
Payment Information *
Week of Camp Working (If Applicable)
Birthdate *
Does your child have any physical limitations/illness that will interfere with their full participation in the camp program?  If Yes, please explain: *
List known allergies: *
List medications currently taking:  (Please clearly label all medicines and write out dosage instructions on a separate sheet of paper for the designated nurse when you bring them to camp.) *
If necessary, do we have permission to give your child: *
Insurance Company & Policy  #
Name of First Emergency Contact *
Relationship to Camper *
Phone Number *
Name of Second Emergency Contact *
Relationship to Camper *
Phone Number *
Name of Third Emergency Contact *
Relationship to Camper *
Phone Number *
Name of Parent or Legal Guardian.  Please type your name in agreement:  In case of emergency and I, as a parent or legal guardian, cannot be contacted, I give my permission for any medical treatment deemed necessary by trained medical professionals.  I understand the camp will not necessarily have such trained medical professionals on duty at the campgrounds.  *
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