2020 Camp Connexion Camper Registration
Camp is June 1-4. We will collect money for registration by smaller payment methods if that is preferred or you can make one payment of $115 by March 15, 2020.
The dates for making payments are:
March 15, 2020- ALL CAMPERS must have a non-refundable deposit of $25 paid to reserve a spot.
April 5, 2020- A second payment of $30 is due.
May 10, 2020- A final payment of $60 or any remaining balance of the total $115 is due for all campers.
What is the campers name? *
Your answer
What grade will the camper complete in the 2019-2020 school year? *
What shirt size will the camper need? *
Please choose a FIRST choice for track time. ***All campers will have a swimming track and 3 additional tracks this year*** *
Please choose a SECOND choice for track time. *
Please choose a THIRD choice for track time. *
Please choose a FOURTH choice for track time. ***This is only a back-up option*** *
What church does the camper attend? *
What age will the camper be on June 1? *
What is the camper's birthday? (mo/day/yr) *
Your answer
What is an email for the camper? *
Your answer
What is the camper's address? *
Your answer
Please list the campers Insurance Information with Group and Policy Number. *
Your answer
Please list Parent Names with Phone Numbers *
Your answer
Please list any other contact names with relationship and phone numbers if there is an emergency. *
Your answer
Please list the camper's physician with a phone number. *
Your answer
Please list any allergies of the camper. *
Your answer
Please list any medication that the camper takes daily that will come to camp. ***All medicine must be in the bottle from the pharmacy with the medicine name and dosing information and parent must meet with the camp nurse at registration!!! NO EXCEPTIONS!!!*** *
Your answer
Please explain any special needs of the camper or any medical issues the camp staff/nurse should be made aware of.
Your answer
I agree that photographs or videos may be taken of my camper and used in promotional materials. *
Required
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 June 1-4, 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. *
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