Emmanuel Bible Camp Registration

Emmanuel Bible Camp Registration
Camper Information
Name *

First Name Last Name
Camper's Date of Birth and Age *
Grade camper is going into *
Week camper wishes to attend *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *

Area Code Phone Number
Email
example@example.com
Parent/Guardian Name *
Parent/Guardian phone *

Area Code Phone Number
Parent/Guardian email
example@example.com
Emergency phone

Area Code Phone Number
Any known allergies
Physical limitations/needs
Permissions
I understand that eligibility for camp sessions is based on current age and/or grade (school year commencing in the Fall). Campers must be entering the 4th grade or above (8 years old and older) to attend Regular Camp, 8th grade - 10th grade to attend Younger Teen Camp, or 10th grade - 19 years old to attend Older Teen Camp. *

Yes No
I hereby grant Emmanuel Bible Camp permission to see to the treatment of my child if he or she becomes ill or is injured during their stay at Emmanuel Bible Camp. I understand that a qualified physician will be contacted if prescription medicines or emergency treatment is deemed necessary. *

Yes No
I hereby give my child permission to go swimming with Emmanuel Bible Camp at the Barbourville Water Park. *

Yes No
I hereby give permission for my child's photograph to be used for promotional purposes by Emmanuel Bible Camp. This includes, but is not limited to slideshows, videos, website, newspapers, and other printed material. *

Yes No
At Emmanuel Bible Camp, we encourage homesick campers to stay to the end of the week to truly experience camp. Our counselors are trained to help children through homesickness so that they have a great and positive camp experience. If, however, a camper remains homesick the Camp Director will contact you and apprise you of the situation. Should the homesickness continue we will continue to keep you apprised of the situation and will make arrangements for you to pick your child up, should you deem that necessary. Parents will be contacted before 8:00pm, and will be contacted after 8:00pm only in the case of a medical emergency. *

I understand the Emmanuel Bible Camp homesick policy I do NOT understand the Emmanuel Bible Camp homesick policy
I understand that there is a $3.00 early withdrawal fee in the case of my camper needing to leave camp before dismissal on Saturday. *

Yes No
I understand that we do not release campers for early withdrawal without the permission of the camper's Parent/Guardian. *

Yes No
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