CRC Summer Camp

We’re so excited to welcome you and your child to camp at the Christian Retreat Center this summer! Please take a moment to fill out the information below so we can ensure we have everything we need to make their experience safe, smooth, and unforgettable.

When paying online, the price of camp is raised about 3% plus .50 cents to help cover the online transaction fee.

If you desire to avoid the additional cost, CRC's office welcomes checks and cash through the mail or in-person. Our mailing address is 369 CRC Drive, East Waterford, PA 17021.

The online form can still be completed and submited to the office without doing an online payment. Please mail in the $50 non-refundable deposit to the office in order to receive your confirmation letter.

Camper's Name*

First NameLast Name

Date of Birth: (Month, Day, Year)*

Age (at the start of camp)*

Biological Birth Sex*

Camp Attending*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent / Guardian Name #1*

First NameLast Name

Relationship to Camper*

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Parent / Guardian Name #2*

First NameLast Name

Relationship to Camper*

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Alternate Contact Name*

First NameLast Name

Relationship to Camper*

Contact Information*

Cell Number:Email Address

Cabin Mate Request #1

Cabin Mate Request #2

In order that CRC may provide the best health care for your child during camp, please list all medications your child is currently taking. Even if your child does not regularly take any medications, this form still needs to be signed and completed. It is generally our practice to call a parent when a major medical issues arises or a camper requires more than one visit to the Nurse’s Station (e.g. injuries requiring more than simple first aid, or for headache, sore throat, etc. that does not respond to treatment.)

Camper Name*

First NameLast Name

Camp Attending*

Is your camper in general good health & able to participate in all normal camp activities? Yes or No. If No, please submit a statement of limitations.*

If necessary, please provide a statement of limitations.

All medications must be turned into the Nurse on the first day of camp and must be in the original packaging/container.

If needed, is our camp nurse able to provide your child Advil?*

If needed, is our camp nurse able to provide your child with Tylenol?*

Prescription Medication: Please list and name all prescription medication, how often the medication is taken, and the reason for use. If no medication is needed, please type NA.*

Non-Prescription Medication (Vitamins, food supplements, etc): Please list and name all non-prescription medication, how often the medication is taken, and the reason for use. If no medication is needed, please type NA.*

Does your child have any dietary needs? What is the reason for the dietary needs? CRC will do our best to accommodate reasonable dietary needs. If you have questions or concerns about food allergies, camp staff encourages you to call or email the office. If no dietary needs are present, please type NA*

Any pre-existing medical condition?*

Any other specific allergies or treatment given?*

Date of last tetanus shot?*

Primary Care Physician*

First NameLast Name

Phone Number for physician*

Please enter a valid phone number.

Insurance Information:*

Insurance CompanyPolicy Number

A confirmation letter will be sent to you via email. CRC's office does our best to send confirmation letters a day or two after a camp registration is received. Please check your spam folder as emails are occasionally automatically sent to this folder.

If your child is attending a Pioneer Camp or Teen Camp, tier pricing is available. Please select the tier that best fits your family budget. Regardless of which tier is picked, the camp quality is the same. Skip this prompt if your child is attending other camp programs.*

For all camps, how do you plan on paying?*

Is your church, or another organization part, or all, of the cost of camp? Please list the church / organization, a representative of the church / organization, and how much the church/organization is contributing to the overall cost. If not applicable, please mark NA.*

The undersigned does hereby release, discharge, indemnify, and hold harmless Christian Retreat Center and The Allegheny and Susquehanna Conferences of the Brethren in Christ Church and all of their parent and affiliated organizations and all of their officers, agents, contractors, directors, members, participants and employees from all claims, demands, actions, judgments, and/or liabilities of whatsoever kind of nature, including any costs, attorneys’ fees, losses or expenses in connection therewith, in any way relative to, arising out of, or by reason of, my participation in, and attendance at, Christian Retreat Center and/or related facilities, including all claims or demands for death or injury to me, or any damage to, or destruction of any of my property arising out of any accident or occurrence with, said attendance, participation and/or presence, whether negligent or otherwise. This waiver, Release and Indemnification is given in consideration of, and as a condition to, permitting the undersigned to participate at Christian Retreat Center. In signing this form, I hereby certify that all information is correct and I give permission for the use of photographs, audio, and video footage including my child in camp publicly, for my child to be transported in a camp operated vehicles for approved out-of-camp activities and for purpose of medical transport, and for the release of medical records in case of illness.

Signature

If you are paying via cash or check and mailing your money to the camp, or if your child is recieving sponsorship funds, please do not select a camp in the below space. Scroll down and press the submit button.

Please select your camp.

Discovery Camp Group 1July 5 - 7

$144.70

Discover Camp Group 2July 8 - 10

$144.70

CRC Day CampJuly 6 - 10

$206.50

Pioneer Camp 8&10 July 5 - 10 / TIER 1

$361.00

Pioneer Camp 8&10 July 5 - 10 / TIER 2

$324.95

Pioneer Camp 8&10July 5 - 10 / TIER 3

$299.20

Pioneer Camp 10&12July 12 - 17 / TIER 1

$361.00

Pioneer Camp 10&12July 12 - 17 / TIER 2

$324.95

Pioneer Camp 10&12July 12 - 17 / TIER 3

$299.20

Pioneer Camp 12&14July 19 - 24 / TIER 1

$361.00

Pioneer Camp 12&14July 19 - 24 / TIER 2

$324.95

Pioneer Camp 12&14July 19 - 24 / TIER 3

$299.20

Teen Camp (14-17)July 26 - 31 / TIER 1

$361.00

Teen Camp (14-17)July 26 - 31 /TIER 2

$324.95

Teen Camp (14-17)July 26 - 31 / TIER 3

$299.20

Camp on the Go!July 27 - 31

$129.25

$50 Deposit for Week of Camp.Remaining balance paid at a later date.

$50.00 Quantity

Enter coupon

Total

$0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

CRC Summer Camp

Medical Form

Payment