Junior and Young Teen Camp 2008
Registration Form
To ensure speedy processing, please fill out legibly and completely.
Please use a separate form for each child registering for camp. Feel free to photocopy this form. This form should be mailed. Parent information will be sent upon receipt of this registration.
Please check one: Junior Camp July 28 August 2 Young Teen Camp July 28 August 2
Name: _______________________________________________
Phone: ( )_________________
Address: _______________________________________ M F
City: ______________________State: ___________Zip: ___________
Date of Birth: _____________ Age: _________Fall 07 Grade________
Church or Youth Group: ______________________________________
Name(s) of Parent(s) child lives with: ____________________________
Parent Email: ______________________________________________
Cabin Mate Request: (No more than 2 names)
___________________________/______________________________
Campers Promise: "I agree to abide by the rules of the camp."
_________________________________________________________
Camper Signature
Parental Agreement: "I approve of the use of pictures taken of my child to be used in promotion. Also, in case of an emergency, I hereby give permission to the licensed physician or Emergency Room personnel at a hospital selected by Heartland Christian Camp to secure proper treatment, hospital care, anesthesia, or surgery for any child named on this form."
_________________________________________________________
Parent Signature
Deposit Information: $25.00 (transferable, but not refundable)
Check enclosed, payable to Heartland Christian Camp
Amount: $_______________________
$5 "late" fee after May 31, 2008
Important Heartland Christian Camp Information:
All campers under the age of 18 must present a health history report completed by a parent or guardian.
Our campers insurance is for injuries only and begins where yours terminates. In the event you have no personal or organizational policy, our policy will provide you with coverage within its limits subject to policy provision.
The use of alcoholic beverages, illegal drugs, other controlled substances, or tobacco are prohibited.
If you must cancel, please notify the camp immediately.
Rules for acceptance and participation in camp activities are equal for all regardless of race, color, national origin, sex, or disability.
Heartland Christian Camp is a ministry of the North Central Conference of the Free Methodist Church of North America.