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Camper Registration and Emergency Contact Information
*
Indicates required field
Camper Name
*
First
Last
DOB
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Male/Female
*
Male
Female
T-Shirt Size
*
Please choose from drop down list
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult X Large
Adult XX Large
Camper's Most recent grade completed
*
Please choose from drop down list
Under 10 years old
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Emergency Contact #1
*
First
Last
Phone Number
*
Email
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Emergency Contact #2
*
First
Last
Phone Number
*
Email
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Camper Medical Information
Camper's Physician
*
Phone Number
*
Medications currently taking
*
Instructions for medications
*
Can your child take over the counter medication?
*
Yes
No
Known Allergies
*
Special Needs/Instructions
*
Fellowship Baptist Church Camp Medical & Liability Release Statement
*I understand that in the event medical intervention is needed, every attempt will be made to contact immediately the persons listed on the registration form. In the event I cannot be reached in an emergency, I hereby give my permission to the physician or dentist selected by the camp director or ministry director to hospitalize, to secure medical treatment and/or to order an injection, anesthesia, or surgery for my child as deemed necessary.
*I understand that my insurance coverage for my child will be used as primary coverage in the event medical intervention is needed. Coverage by Camp Fairview and/or Fellowship Baptist Church through its accident policy will be used as a back up for what my family's insurance does not cover.
*I understand all reasonable safety precautions will be taken at all times by Camp Fairview and/or Fellowship Baptist Church and its agents during the events and activities. I understand the possibility of unforeseen hazards and know the inherent risk. I agree not to hold Camp Fairview and/or Fellowship Baptist Church, its leaders, employees, and volunteer staff liable for damages, losses, diseases, or injuries incurred by the subject on this form.
*I understand that Camp Fairview and/or Fellowship Baptist Church reserves the right to discipline or dismiss my child from camp with forfeiture of fees if he/she is non-cooperative or noncompliant.
*I further agree to indemnify and hold Camp Fairview and/or Fellowship Baptist Church harmless against any and all costs, damages, and expenses which may be incurred by them as a result of any claim I may make, actions I take against the camp, or lawsuits I may file against them.
*I give permission for my child's picture to be used in future camp publications, promotional videos and/or on the internet.
*I agree to the above Parent Medical and Liability Release Statement.
Have you read and do you agree to above Medical and Liability Release
*
Yes
No
Parent/Guardian Name
*
First
Last
Date
*
Submit
Worker/Counsellor Registration
*
Indicates required field
Name
*
First
Last
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Gender
*
Male
Female
T-Shirt Size
*
Please choose from drop down list
Small
Medium
Large
X Large
XX Large
Email
*
Allergies
*
Phone Number
*
Submit
Home
About
Our Pastor
What We Believe
Free Gift
Media
Connect
Missions
Give
In His Name
VBS 2024