Homepage

Registration for camp is open! Sign up here!

2017 Camp Registration Form


Basic Information:

Camper's Name:
Gender:

Camper's Birthdate:


Parent/Guardian's Name:


Address:


City:


State:


ZIP code:


Phone:


Email: (optional)


Church: (optional)



Please select the weeks your child is planning to attend:
Day Camp #1Western Week
Day Camp #2Fiesta of Faith
Teen CampRedneck Roundup
Day Camp #3Astronaut Adventure
Junior CampRedneck Roundup
Day Camp #4Arctic Summer
Junior High CampCastle Conquest
Day Camp #5Jungle Journey


Medical Questionnaire:
Does your child have any allergies to medications?
If yes, please explain:


Does your child have any allergies to food products?
If yes, please explain:


Does your child have any allergies to environmental
elements such as insect bites?
If yes, please explain:


Does your child have any special needs we should
know of to accommodate their stay with us?
If yes, please explain:


If necessary, do we have your permission to give your child:
•Ibuprofen (Motrin)
•Oral diphenhydramine
•Topical diphenhydramine
•Acetaminophen (Tylenol)
•Antibiotic ointment

Health Insurance:


Name of health insurance policy holder:


Insurance policy number:


Company:



Parent/guardian contact information (optional)

Mobile:

Work:

Other:

If your child has medicine that must be administered during their stay with us, please fill out the medication form located here and bring it to registration.

To receive the early registration discount and reserve your child's place: The non-refundable resident camp registration fee of $50.00 must be received by the camp. See here for mailing address. This form must be submitted by May 30, 2017 at 11:59pm to receive the early registration discount.

In case of emergency: I understand every effort will be made to contact me. However, if I cannot be reached, I give permission for the physician selected by the camp director to secure proper medical treatment for my child.

By submitting this registration: I give my permission for the camp to use my child's photograph in camp promotional information.