Way of Life Christian Camp - Camper Registration 2017
The 2017 Way of Life Christian Camp will be July 2nd- July 7th at Camp Nuhop and the camper fee will be $200.00.

This form must be COMPLETELY filled out and submitted.
You will not need to complete a paper copy.
Campers must sign up for the High Ropes by May 31st (Ages 13+).

Questions concerning registration may be directed to Cathy Rehn at (513) 675-0138 or CathyRR@yahoo.com

Way of Life Christian Camp
c/o Cathy Rehn Checks Payable to: Central Church of Christ
3501 Cheviot Ave Memo: Way of Life Christian Camp
Cincinnati, OH 45211 Payment can be made in full at Camp

Additional Items
What additional line items would you like to purchase?
All campers will receive a free T Shirt. Please indicate the size.
Last Name, First Name *
Your answer
School Grade in 2017-18 *
Age as of 7/3/17 *
Your answer
Date of Birth (--/--/----) *
Your answer
Gender *
Camper Email Address
Your answer
Parent/Guardian Email Address
Your answer
Home Address (Street Address) *
Your answer
Home Address (City/State/Zip) *
Your answer
Home Phone
Your answer
Camper Cell Phone
Your answer
Emergency Contact 1: Name *
Your answer
Emergency Contact 1: Relationship *
Your answer
Emergency Contact 1: Address (Street Address) *
Your answer
Emergency Contact 1: Address (City/State/Zip) *
Your answer
Emergency Contact 1: Phone *
Your answer
Emergency Contact 2: Name
Your answer
Emergency Contact 2: Relationship
Your answer
Emergency Contact 2: Phone
Your answer
Limited Activity *
Does the camper have limited activity?
Swimming Permitted *
Is the camper allowed to swim in a lake or pool?
Medications
Please list the medications that the camper takes.
Your answer
Allergies
Please list known allergies of the camper.
Your answer
Dietary Restrictions
Please explain the dietary restrictions of the camper.
Your answer
Over the Counter Medications *
Do you give permission for the medical staff to administer OTC medications?
Hospital Transport / Treatment *
Do you give permission for the staff to transport / treat the camper in event of an emergency?
Last Tetanus Shot (--/--/----) *
What is the date of the last tetanus shot of the camper?
Your answer
Recent Disease Exposure
Please explain any recent disease exposure of the camper.
Your answer
Family Physician (Name & Phone Number) *
Please provide the name and phone number of your family physican.
Your answer
Family Dentist (Name & Phone Number) *
Please provide the name and phone number of your family dentist.
Your answer
Insured Person & Relationship *
Please provide the name and relationship of the insured person of the camper.
Your answer
Insurance Carrier *
Please provide the carrier name of the camper insurance.
Your answer
Insurance I.D. Number *
Please provide the I.D. Number of the camper insurance.
Your answer
Insurance Group Number *
Please provide the Group Number of the camper insurance.
Your answer
Insurance Phone Number *
Please provide the Phone Number of the camper insurance.
Your answer
Parent Consent *
I, the parent or guardian of the applicant certify that he/she is in good health and that I understand there are camp rules which must be followed in the best interest of all concerned, and that I will cooperate with camp management.
Parent Promotional Consent *
I authorize Way of Life Christian Camp to use my child’s photograph or likeness for promotional purposes.
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