Camp Christian, Inc

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2019 Jr/Sr High Winter Retreat
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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If camper is coming with a friend, please list friend's name above.
Parent/Guardian Information
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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 contact 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.

Payments
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$