CAMPER REGISTRATION FORM

Important Reminders:

CAMPER INFORMATION

Male
Female
Check here to remove your camper's contact information from the camper directory.

REFERRAL INFORMATION

Yes
No
Church
Online search
Social media
Radio or newspaper
Friend or family member
Other

PARENT/GUARDIAN INFORMATION

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PARENT/GUARDIAN 2 INFORMATION

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EMERGENCY CONTACT (EC) INFORMATION

MEDICAL HISTORY

None
Fainting
Asthma
Hay Fever
Headaches
Upset Stomach
Seizures
Bee Stings (allergic reaction)
Nosebleeds
Bed Wetting (if so, please send adequate linens)
Other
Camper has permission to receive all OTC treatments
Pain relievers (Advil, Midol, etc.)
Fever reducers (Tylenol, Motrin, etc.)
Anti-allergens (Benadryl, Zyrtec, etc.)
Indigestion relievers (Tums, Pepto-Bismol, etc.)
Topical antibiotic creams (Neosporin, Bacitracin, etc.)
Topical anti-itch creams (Caladryl, Cortisone)
Sun burn care (sun screen, aloe vera gel, etc.)
Electrolyte replacement drinks (Gatorade, Powerade, etc.)
Other

INSURANCE INFORMATION

Yes
No

MEDICAL RELEASE STATEMENT

CABIN MATE REQUEST

CAMP POLICIES

PAYMENT INFORMATION

Young Explorers: June 7-9, 2018
Senior High: June 10-15, 2018
6th, 7th, & 8th Grade: June 17-22, 2018
3rd, 4th, & 5th Grade: June 24-29, 2018 **FULL**
5th, 6th, & 7th Grade: July 8-13, 2018
4th, 5th, & 6th Grade: July 15-20, 2018 **WAITLISTING FOR BOYS**
Email
US Mail

Yes
No

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