This form must be filled out for each individual who will be attending Family Camp.  Please make notes at the bottom of the form to clearly state if members will be staying together in a facility.

*Camper's Promise: I agree to abide by the rules of the camp.  (For campers under the age of 19.)
Name             

*Adult Camper Signature:

*Parental Agreement:
I approve of the use of pictures taken of my child to be used in promotion.  In an emergency, I hereby give permission to the licensed physician selected by Heartland Christian Camp to secure proper treatment, hospital care, anesthesia, or surgery for any child named on this form.
Name             

NOTES/COMMENTS:

$5.00 Late Fee After April 14, 2007