Building Lives
for Eternity1 Corinthians 3:11

CAMPER REGISTRATION

CAMPER INFORMATION (Required)

Camper Name * Date of Birth * Age * Gender * Grade Going Into * T-Shirt Size *

CAMP SELECTION (Required)

Camp Type / Session *

Registration Fee: $0

PARENT / GUARDIAN #1 (Required)

Name *Relationship *Address *City *State *ZIP *Primary Phone *Work Phone / N/A *Email *

PARENT / GUARDIAN #2 (Optional)

NameRelationshipAddressCityStateZIPPrimary PhoneWork PhoneEmail

AUTHORIZED PICKUP PERSONS

All authorized persons must have a valid picture ID. Enter N/A in unused spaces.

Authorized Person #1 Name *Relationship *Phone Number *

Authorized Person #2 Name *Relationship *Phone Number *

Authorized Person #3 Name *Relationship *Phone Number *

MEDICAL INFORMATION (Required)

Allergies (Medications, Foods, Environmental, etc.) *Medical Conditions — List Current or Significant Conditions *Current Medications *Other Information / Special Needs / Dietary Needs *

PERMISSIONS & RELEASE (Required)

I give my permission for my child to participate in any camp related activity. I am aware that this includes swimming, use of the waterslide, ziplining, use of kayaks and any other activity that the camp may offer.

I give permission to use my child’s photograph, video recording or audio recording for promotional purposes as well as maintaining a historical record. I understand photographs may be used in print publications, online publications, presentations, websites and social media.

I allow my child to sign themselves out should they drive their own automobile to camp.

I hereby release Faith Christian Camp from any responsibility other than normal supervision and care.

I understand camp insurance is secondary to my own policy.

I understand camp admission fees are non-refundable.

Parent / Guardian Signature * Sign below with your finger, mouse, or trackpad.

Date *

ADDITIONAL ACKNOWLEDGMENTS (Required)

I understand that registration is not complete until full payment has been received unless authorized by the camp office. I understand that camp registration/admission fees are non-refundable. I have read and understand the information, permissions, releases, and policies contained in this registration form.

PAYMENT

Full payment is required to complete registration. After submitting this form, you will be redirected to Square to securely complete your payment unless payment has been authorized by the camp office.

FOR OFFICE USE ONLY

Authorization Code Leave blank unless provided by the camp office.

OFFICE USE ONLY — NOTES

For Faith Christian Camp staff use only.