PERSONAL INFORMATION

PERSONAL INFORMATION

*indicates required field
Camper Name: *

First Name Last Name

Address *

Street Address
Street Address Line 2
City	State
Zip Code	Country

Gender *
Age *
Birth Date: *

Month Day Year
Camper Email: *
Parent/Guardian Name *

First Name Last Name
Home Phone: *

Area Code Phone Number
Cell Phone: *

Area Code Phone Number
Parent Email: *
example@example.com

Other contact in case of emergency: *

First Name Last Name
Phone Number: *

Area Code Phone Number
Relationship to camper: *
Person other than parent that child may go home with:

First Name Last Name
Church: *
Pastor's Name: *

First Name Last Name
Church email: *
example@example.com
How did you hear about NEWC?: *

MUSICIAN/SINGER INFORMATION
Primary Instrument *
Secondary Instrument *
WORKSHOP SIGN-UPS
Please select the workshops you wish to participate in during North East Worship Camp 2020. Descriptions for workshops can be found here.
Tuesday, July 14th
Wednesday, July 15th
Thursday, July 16th (AM)
Thursday, July 16th (PM)
Friday, July 17th

CAMPER/PARENT COMMITMENT & AGREEMENT FORMS
TEEN COMMITMENT (must be signed and acknowledged by camper) *
Camper Signature *
PARENT AGREEMENT (must be signed and acknowledged by parent) *
Parent Signature *

PARENT HEALTH FORM

Please answer the following questions regarding your child.
Has teen had any recent illness or injury? If so, what and when? *
Does teen have any special challenges (e.g. ADHD, behavior disorders, physical/mental conditions, special diet needs)? If so, list below and call our office to verify if we can accommodate your teen’s needs. *
Is your teen under medical care or have a history of any medical conditions? (i.e. asthma, diabetes, seizures) *
HEALTH INSURANCE INFORMATION
Carrier *
Type *
Policy Number *
In whose name? *
OVER-THE-COUNTER MEDICATION AUTHORIZATION
Please provide consent for common over-the-counter (OTC) medicines to be given to your teen based on the labeled dosing and weight of your child as deemed necessary by NEWC personnel. *

YES, I approve of NEWC personnel providing common OTC’s to my child as needed. NO, I do NOT approve of NEWC personnel providing my child OTC’s without myverbal consent for which I am providing a number where I can be reached easily.
If you answered no, please provide two telephone numbers below.

Area Code Phone Number
Area Code Phone Number
Parent/Legal Guardian Signature *
Authorization to Consent to Medical Treatment/Activities Consent

As the parent or legal guardian of the above named teen, in the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by the camp director to hospitalize, secure proper treatment for, and order injection, anesthesia, or surgery for my child as named above. I will not hold NEWC or its staff responsible for any injuries or damages related to obtaining or consenting to such medical treatment. I also give permission for the teen to participate in all camp activities, except as noted on this form. I declare that the health information I have provided in this application, to the best of my knowledge, is true, correct, and complete.
Parent/Legal Guardian Signature *
Date Signed *

Month Day Year
Date

YOU'RE ALMOST FINISHED!
Please download the following form to be completed by your child's Dr., P.A., or Pediatrician.

Completed forms can be scanned and emailed to: neworshipcamp@gmail.com

OR mailed to New Hope Fellowship, PO Box 96, East Bloomfield, NY 14443.
PHYSICIAN HEALTH FORM
Once your form is submitted you can head over to our camp merchandise page where you can select to make an online payment for registration.

If you do not wish to pay online you may also send a check to our camp office:

NEWC, c/o New Hope Fellowship, PO Box 96, East Bloomfield, NY 14443.

Please make all checks payable to "NEW HOPE FELLOWSHIP".

NOTE: Your registration is not finalized and your spot is not confirmed until the physician health form and payment is received in full and our office has confirmed your registration by email. Please contact us with any questions you have.
Should be Empty:

PERSONAL INFORMATION

MUSICIAN/SINGER INFORMATION

WORKSHOP SIGN-UPS

CAMPER/PARENT COMMITMENT & AGREEMENT FORMS

PARENT HEALTH FORM

HEALTH INSURANCE INFORMATION

OVER-THE-COUNTER MEDICATION AUTHORIZATION

YOU'RE ALMOST FINISHED!