Camp Christian, Inc

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2018 Summer Camp Registration
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If your child will be attending more than one summer camp program, you may choose all that apply. (One camper can be registered for multiple programs with this form)
Contact Information
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First Name
Last Name
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Please let us know if camper has a nickname (ie: Elijah goes by Eli)
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Please format MM/DD/YYYY
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only if have home phone


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*Parents will be contacted for permission if camper expresses desire to be baptized*
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Information on who the camper RESIDES with
Please list only information for the people whom the camper lives with. Other parents who the camper does not live with can be listed under the alternate emergency contact.

First Name
Last Name
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First Name
Last Name
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First Name
Last Name
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Please list name and phone number

Liability Release: I release Camp Christian, including it's directors, employees and agents from my child's physical injury, including death, or illness while at camp, including Camp Christian sponsored travel to and from camp.  I will assume the risks associated therewith, whether known or unknown to me at this time.  This release is also intended to include all claims of my family, estate, heirs, personal representatives or assigns.

Off Camp Release: My child has permission to be transported for medical care or to participate in programs conducted off the Camp Christian grounds.  It is understood that off ground programs are supervised by qualified camp faculty.

Publicity Release: I give permission to Camp Christian staff or the assigns to use photos, videos & audio recordings in promotional materials and/or post them on the camp's website or social media.

General: I recognize that this is a Christian camp, the Bible will be studied, and camper conduct and dress is expected to be in line with Christian values.  I understand that my camper is expected to attend all sessions and activities.  I also understand that if my child refuses to conduct himself/herself in this manner, I may be required to pick up my camper.

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By typing my name above, I acknowledge that I have read and agree to the above agreements.
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(mm/dd/yyyy)
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ALLERGIES:  Please lis any food, medication and insect allergies.  Describe reaction & management of reaction


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MEDICATIONS:  Please list all medications (Prescription/Over-the-counter/Vitamins/Herbs) below.  ALL medication must be in the ORIGINAL CONTAINER and will be left with and dispensed by the Health Supervisor.  Medicines must be kept in the original packaging/bottle that identifies the prescribing physicial (if prescription), name of medicine, dosage & frequency.  We understand that medications may change and will update this at check-in.

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Health Center Medications
These medications are stocked at Camp Christian. Please indicate your permission to administer these over-the-counter medications, or if you wish to be notified first. (Some meds are listed as common brand names, though generic may be substituted.)
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To the best of my knowledge, my child is physically and emotionally able to take part in the camp program.  In the event of a medical emergency, I give my permission to those in charge at Camp Christian to seek necessary medical attention from qualified personnel (Nurse, Physician, EMT or other Medical Professionals) to do what is necessary for the health and well-being of my child.  I give my permission for emergency medical care to be administered if necessary, understanding that every effort will be made to contact me.

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By typing my name above, I certify that I have read and agree to the above statements.
FRIEND DISCOUNT
Bring a friend who has never attended a Camp Christian program & you EACH receive a discount!

Friend discounts are as follows:

$20 - Sr High, Junior 1, The Arts, Jr High, & Junior 2

$10 - First Chance

 

I am bringing the following friends:




I am coming for the first time with:



Let us know if your church will be covering part of your camper fees.
Payments
Please choose the amount you wish to pay toward camper fees, mission money & store cards. You may choose to pay an amount other than shown by clicking on the empty box. Payments must be at least $30 for EACH camp for which you are registering (unless paying 1/2 for Day Camp or Overnighter Camp).
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Mission Cards and Store Cards
Please indicate the amounts for missions and store cards for your camper. NOTE: Camp store cards come in increments of $5.00 (except for Day Camp). If you are paying for these cards now, please add the total below.
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Please indicate the amount you would like to contribute toward our summer mission: HIS PLACE
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Please indicate the amount you would like for your camper to have for the camp store. REMEMBER: Store cards come in increments of $5.00 (Except for day camp)
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