Camp Registration | Freedom Church

If you are a human and are seeing this field, please leave it blank.

Fields marked with an * are required

All campers must complete a registration form.

First Name *

Last Name *

Gender *

Male
Female

Name of the church you attend

Birthdate *

Email *

Address 1

City

Zip / Post Code

Phone

Parent/Legal Guardian

Emergency Phone Number 1 *

Emergency Phone Number 2 *

Do you give permission for the camper to participate in swimming? *

Do you give permission for the camper, if under 18, to participate in water baptism? *

Name of person picking up your child on Sunday

Phone Number

Medical Information

Family Physician *

Family Physician Phone Number

Does your family have health insurance?

Please bring a copy of your insurance card to check in or provide information below.

Insurance Company Name

Policy Number

Group Number

Please list any medical conditions the camp staff need to be aware of and/or comments

Special diet/food restrictions? *

If yes, please specify

Are there any activities that the camper should not participate in? *

If yes, please specify

Any Food or Drug Allergies? *

If yes, please specify (bee sting, food or medication allergy)

Please list medications that will need to be given at camp:

Medication 1

Dosage

Time to be given

Reason

Medication 2

Dosage

Time to be given

Reason

Medication 3

Dosage

Time to be given

Reason

Medication 4

Dosage

Time to be given

Reason

Medication 5

Dosage

Time to be given

Reason

Please use the area below to list any additional medications. Please include the dosage, time to be given, and reason for each medication.

Photograph, Video, and Web Release Form

I hereby give permission for images of my child and their likeness, with or without name recognition, taken by video, photography, and/or a digital camera to be copyrighted and/or used solely for the purposes of Freedom Church promotional and/or advertising material, website, and publications, whether print and/or electronic, which includes provision to include statements, such as testimonials, quotes, etc. I waive any rights of ownership or compensation thereto.

This release shall remain in effect for each child until that child reaches legal age or this release is rescinded by a parent or audit guardian.

I have read and accept the above.

Parent/Legal Guardian's Signature

Release of Liability

I understand that if any accident should occur or any sickness, it is my own responsibility. It is understood that Freedom Church Youth Camp will not be held liable for any expense in such case. In case of emergency, I understand that EVERY effort will be made to contact parents/guardians listed on application. If I cannot be reached, I hereby give permission to the physician to secure proper treatment, care, even hospitalization for my child as named above. I also understand that ALL medications must be administered by the assigned adult staff member for all campers less than 18 years of age. Medications must be registered in at time of registration, labeled with camper’s name, dosage & time of dispensing.

I understand that by placing my name in the signature blanks below, I am agreeing to abide by all rules, policies and discipline of Freedom Church and the camp as set forth by the director and staff, and consent to the above stated information and release of liability.

Parent/Legal Guardian's Signature

Along with the leaders and other youth, I agree to conduct myself in a Christian manner. I promise to respect God, respect others, and respect property. I agree to strive to make each activity the best it can be. I understand that my agreement holds me responsible to these things and the consequences thereof. I am agreeing to abide by all rules, policies, and discipline of the Campground and camp as set forth by the Director and Staff. By signing this consent, I understand that action will be taken and I am subject to being sent home if I partake in any of the following activities: possession of illegal drugs, non-prescribed medications, alcohol or tobacco products, possession of weapons, disrespect for authority, or any other activity that adult leaders deem as inappropriate. I understand that cell phones, ipods, and electronic equipment may be taken up by camp staff if used inappropriately.

Camper's Signature

Parent/Legal Guardian's Signature

Once you have submitted your application, be on the look out for a registration email with more details regarding check in, what to pack, etc.

CAMP REGISTRATION FORM