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2022 Adult and Me

June 18 children ages 3 and 4 to experience a day of camp with an adult support person.

Contact Information
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First Name
Last Name
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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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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



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.
HEALTH QUESTIONAIRE

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 physician (if prescription), name of medicine, dosage & frequency. Any non-prescription or over the counter preparations INCLUDING allergy meds, vitamins and herbs must be accompanied by a Dr's note.  We understand that medications may change and will update this at check-in.

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(mm/dd/yyyy)
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Does your child have any of the following?
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Please list any information that would help our faculty connect with your child. Special needs, dietary restrictions, social/emotional needs, if your child receives educational or behavioral supports at school, etc.

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Is camper taking medication, vitamins, herbs, supplements, OTC Allergy Medicine etc.

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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.
PAYMENT
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. You must at least pay the deposit amount.
Please Note:

The price of $35 includes both Adult and Camper Tuition. Deposits are nonrefundable.  If your camper is unable to attend, we will refund your payment amount minus the deposit required. Please contact the camp office if you have any questions.

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MISSION CARD AND STORE CARDS
Please indicate the amounts for missions and store cards for your camper. You may pay now or at registration. If you are paying for these cards now, please add the total below. NOTE: Store Card balances are typically donated to missions at the end of the week. If your child is attending multiple camps you may keep your balance and/or add to it for the next camp.
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Please indicate the amount you would like to contribute toward our summer mission
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Please indicate the amount you would like for your camper to have for the camp store.
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