Important Information
Applications and deposit received by June 6, 2022 will ensure a full price of $ 180.00 per camper.
Applications after June 6, 2022
All applications received after June 6, 2022 will be $200.00 per camper. The Final deadline for applications is June 12, 2022. NO EXCEPTIONS.
Refunds
There is limited space. Applications will be received on a first come, first served basis. Camp Capacity is limited to the first 125 campers. Cancellations prior to June 12, 2022 will receive a full refund.
Deposits
A $75.00 deposit per camper must be submitted with this application or you may choose to pay in full.
Choose your Camper(s) Drop Off Time (SCROLL DOWN IN THIS FIELD FOR MORE TIMES IF NEEDED)
Packing, arriving, and having fun!
What to Bring to Camp
FRIENDBIBLEBedding (Twin size)Current MedicationsTowelsSwimsuitsClosed Toed ShoesClothes for Theme NightsSoapWater ShoesMODEST clothing (knee-length shorts)FlashlightBall GloveBug SpraySun ScreenMoney for Snacks/Crafts
Prohibited Items (Do NOT bring to camp.)
Electronic Devices, Weapons/Knives, Water Balloons, Drugs/Alcohol, Tobacco Products (Including Vape Pens), Eno/Hammocks, Fireworks, Immodest Clothing, Lighters/Matches
Where do I go?
Camp Leatherwood is located 1 ½ miles north of White Bluff on Highway 47 (Charlotte Hwy). Tum right on Westcott Road, and go one mile. The road ends at Camp Leatherwood.
What do we do at camp?
The following activities will be provided for all campers:*Bible study and worship* All meals* Times for volleyball, basketball, softball, horseshoes, badminton,and otherorganized games* Valuable lessons on how to apply Christian principles to daily life*Devotions and other quiet times*Swimming* Opportunities to develop friendships that you will always remember*Crafts and snacks (at camper's cost)
Rules of Conduct
I. All campers must follow and obey all instructions from any staff member at any time. Campers must participate in all activities. 2.Boys are not permitted in the girls' cabin area at any time. Girls are not permitted in the boys' cabin area at any time. This applies to parents and visitors, except during move-in and move-out times. 3.All campers and staff must wear shorts at least as LONG as the tip of their fingers when hands are fully extended at their sides. NO midriffs/stomachs or underwear should show at any time. Boys must wear shirts at all times. 4.Campers are not allowed out of their cabins after lights out except to visit the bathhouses. 5.Campers are not to write on, destroy, or deface property of the camp or another person. 6.Only registered campers may spend the night or participate in the camp's activities. Visitors are welcome during the evening services. 7.Outside food and drink are not allowed. Parents and/or visitors should not bring outside food or drink on site. 8.Campers are not to engage in any raiding of cabins, horseplay, smearing of shaving cream, or water play in the cabins. Campers are strictly forbidden to engage in any activity which is harmful to another person and his/her property. Campers are not to climb trees or throw rocks. 9.In the event of a reasonable suspicion, Mid-Summer Bible Camp reserves the right to search any camper’s belongings at any time and to remove any items judged to be dangerous, harmful, or inappropriate. The camp director will conduct all searches. I0. DO NOT LEAVE camp without written permission from parent/guardian. You are re- quired to sign out and sign in upon your return. A sign-out sheet will be provided in the dining hall for this purpose.
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Your Camper(s) Guardians!
Use this space to add the important people in your camper’s or campers’ life! ***If this information is DIFFERENT for each of your campers then please complete 2 separate applications.***
1st Parent/Guardian Name
*
1st Parent/Guardian's phone number
*
Please include area code
1st Parent/Guardian's Email Address
*
2nd Parent/Guardian Name
2nd Parent/Guardian phone number
Please include area code
Additional Emergency Contact Name (If parent(s) cannot be reached)
*
Parents are always attempted to be contacted first.
Emergency contact phone number
*
Please include area code
What's your home congregation?
Who can pick-up your camper from camp? Only listed individuals will be ALLOWED to pick-up your child. List ALL individuals that may pick-up your camper.
*
This is in addition to the guardians listed above.
Your Camper’s or Campers’ Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
I am going to register _________ with the information provided above on this one application. (If any of the guardian information is different then another application should be completed for that camper.)
1 Camper
2 Campers
3 Campers
4 Campers
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Camper #1 Information
Camper’s Name
*
First Name
Last Name
Age
*
Gender
Male
Female
Birth Date
Please select a month
January
February
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Your camper's T-shirt size
*
Youth XSmall
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult XL
Adult 2XL
Adult 3XL
What grade level is your camper GOING into?
*
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Victory lap! (2021 High School Grad)
What school does your camper attend?
*
WBES
CES
KSES
WJMS
BMS
HMS
CWHS
DHS
HHS
Home Schooled
Other
Does your child take any medications?
*
Yes
No
Please list all medications that your camper takes. Include dosage and instructions. (All medications must be turned into the camp nurse at check-in. Please have camper's name, directions, and proper dosage in written form in a zip-lock bag.)
*
Does your camper have any allergies or conditions we should be aware of?
*
Yes
No
List all allergies and conditions that the nurse, camp staff, and/or counselors should be aware of during camp. PLEASE CONFIRM LIST WITH NURSE AT DROP OFF
*
Emergency Information for Camper #1
IN CASE OF ACCIDENT, INJURY OR SERIOUS ILLNESS, parents will be notified at once. Campers will be taken to the nearest Emergency Room if parents or the emergency contact person(s) cannot be located within a reasonable length of time. Mid-Summer Bible Camp covers all campers with ACCIDENT INSURANCE ONLY.
What is your preferred hospital?
*
Who is your camper's physician/pediatrician?
*
What is your camper's physician/pediatrician phone number?
*
You've registered one camper! Do you need to register a second?
Yes, I need to register another camper.
No, I'm just registering one.
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Camper #2 Information
Camper’s Name
*
First Name
Last Name
Age
*
Gender
*
Male
Female
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
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November
December
Month
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Year
Your camper's T-shirt size
*
Youth XSmall
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult XL
Adult 2XL
Adult 3XL
What grade level is your camper GOING into?
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Victory lap! (2021 High School Grad)
What school does your camper attend?
*
WBES
CES
KSES
WJMS
BMS
HMS
CWHS
DHS
HHS
Home Schooled
Other
Does your child take any medications?
*
Yes
No
Please list all medications that your camper takes. Include dosage and instructions. (All medications must be turned into the camp nurse at check-in. Please have camper's name, directions, and proper dosage in written form in a zip-lock bag.)
*
Does your camper have any allergies or conditions we should be aware of?
*
Yes
No
List all allergies and conditions that the nurse, camp staff, and/or counselors should be aware of during camp. PLEASE CONFIRM LIST WITH NURSE AT DROP OFF
*
Emergency Information for Camper #2
IN CASE OF ACCIDENT, INJURY OR SERIOUS ILLNESS, parents will be notified at once. Campers will be taken to the nearest Emergency Room if parents or the emergency contact person(s) cannot be located within a reasonable length of time. Mid-Summer Bible Camp covers all campers with ACCIDENT INSURANCE ONLY.
What is your preferred hospital?
*
Who is your camper's physician/pediatrician?
*
What is your camper's physician/pediatrician phone number?
*
You've registered two campers! Do you need to register a third?
Yes, I need to register another camper.
No, I'm just registering two.
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Camper #3 Information
Camper’s Name
*
First Name
Last Name
Age
*
Gender
*
Male
Female
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
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1932
1931
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1929
1928
1927
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1925
1924
1923
1922
1921
1920
Year
Your camper's T-shirt size
*
Youth XSmall
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult XL
Adult 2XL
Adult 3XL
What grade level is your camper GOING into?
*
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Victory lap! (2021 High School Grad)
What school does your camper attend?
*
WBES
CES
KSES
WJMS
BMS
HMS
CWHS
DHS
HHS
Home Schooled
Other
Does your child take any medications?
*
Yes
No
Please list all medications that your camper takes. Include dosage and instructions. (All medications must be turned into the camp nurse at check-in. Please have camper's name, directions, and proper dosage in written form in a zip-lock bag.)
*
Does your camper have any allergies or conditions we should be aware of?
*
Yes
No
List all allergies and conditions that the nurse, camp staff, and/or counselors should be aware of during camp. PLEASE CONFIRM LIST WITH NURSE AT DROP OFF
*
Emergency Information for Camper #3
IN CASE OF ACCIDENT, INJURY OR SERIOUS ILLNESS, parents will be notified at once. Campers will be taken to the nearest Emergency Room if parents or the emergency contact person(s) cannot be located within a reasonable length of time. Mid-Summer Bible Camp covers all campers with ACCIDENT INSURANCE ONLY.
What is your preferred hospital?
*
Who is your camper's physician/pediatrician?
*
What is your camper's physician/pediatrician phone number?
*
You've registered three campers! Do you need to register a fourth?
Yes, I need to register another camper.
No, I'm just registering three.
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Camper #4 Information
Camper’s Name
*
First Name
Last Name
Age
*
Gender
*
Male
Female
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
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10
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31
Day
Please select a year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
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2006
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2002
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2000
1999
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1993
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1991
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1982
1981
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1979
1978
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1975
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1973
1972
1971
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1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Your camper's T-shirt size
*
Youth XSmall
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult XL
Adult 2XL
Adult 3XL
What grade level is your camper GOING into?
*
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Victory lap! (2021 High School Grad)
What school does your camper attend?
*
WBES
CES
KSES
WJMS
BMS
HMS
CWHS
DHS
HHS
Home Schooled
Other
Does your child take any medications?
*
Yes
No
Please list all medications that your camper takes. Include dosage and instructions. (All medications must be turned into the camp nurse at check-in. Please have camper's name, directions, and proper dosage in written form in a zip-lock bag.)
*
Does your camper have any allergies or conditions we should be aware of?
*
Yes
No
List all allergies and conditions that the nurse, camp staff, and/or counselors should be aware of during camp. PLEASE CONFIRM LIST WITH NURSE AT DROP OFF
*
Emergency Information for Camper #4
IN CASE OF ACCIDENT, INJURY OR SERIOUS ILLNESS, parents will be notified at once. Campers will be taken to the nearest Emergency Room if parents or the emergency contact person(s) cannot be located within a reasonable length of time. Mid-Summer Bible Camp covers all campers with ACCIDENT INSURANCE ONLY.
What is your preferred hospital?
*
Who is your camper's physician/pediatrician?
*
What is your camper's physician/pediatrician phone number?
*
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Photo and Video Release Form
I, the parent or legal guardian of the aforementioned camper(s) grant Camp Leatherwood and/or any associated organizations (i.e. churches, staff) my permission to photograph and/or video my child(ren) and use such content for any legal use, including but not limited to: publicity, copyright purposes, illustration, advertising, and web content. Furthermore, I understand that no royalty, fee or other compensation shall become payable to me by reason of such use.
Do you agree to the above policy?
*
Yes, I agree to the Photo and Video Release Form.
No, I do not want my child’s photographs/videos or children's photographs/videos to be used in any way.
Medical Care Access Agreement
In the event that my camper becomes seriously ill (physically or mentally) or is injured while a camper at Midsummer Bible Camp then the camp staff has my permission to seek medical care as they see fit and if needed arrange for transport to any hospital, emergency room, or physician's office for treatment. I also agree that I will assume responsibility for any incurred expenses. Please sign below to agree and acknowledge.
*
I agree and will assume responsibility should such an event occur.
LIABILITY RELEASE FORM FOR MIDSUMMER BIBLE CAMP 2022
This instrument is executed by the undersigned in connection with the participation of his/her or their minor child in activities conducted by or in connection with the Midsummer Bible Camp. In consideration for being accepted or permitted to participate by Midsummer Bible Camp, we(I) being 21 years of age or older, do hereby release, forever discharge, and agree to hold harmless the directors thereof and the adult chaperones of Midsummer Bible Camp, from any and all liability, claims or demands for personal injury, sickness of death, as well as property damage and expenses of any nature whatsoever which may be incurred by the undersigned and/or the child-participant while said child is participating in the Mid-Summer Bible Camp. Furthermore, we(I) hereby assume all risk of personal injury, sickness and death, damage and expense as a result of our(my) child-participant's involvement if the Midsummer Bible Camp. Furthermore, the Midsummer Bible Camp acting and through its employees or adult chaperones are hereby granted authority and permission to furnish any necessary transportation, food and lodging for our (my) child-participants in connection with Midsummer Bible Camp. The undersigned further hereby agree to hold harmless and indemnify Midsummer Bible Camp, Camp Leatherwood, the directors, and adult chaperones of the Midsummer Bible Camp for any purported liability sustained as a result of the negligent, willful, or intentional acts of our(my)child-participant, including expenses incurred attendant thereto. Our(my) signature(s) below further evidence our(my) permission for the below named child to participate fully in Midsummer Bible Camp.
Do you accept the liability of release form as stated above?
*
I have read and agreed to the terms of the liability release form.
Print your name here if you agree that the information provided is accurate, that your preferences are indicated correctly and are binding, that you have agreed to cover any medical expenses incurred due to any injury that occurs while at camp, and that you are accepting the liability of release as stated in this application.
*
By signing below you are agreeing that the information provided is accurate, that your preferences are indicated correctly and are binding, that you have agreed to cover any medical expenses incurred due to any injury that occurs while at camp, and that you are accepting the liability of release as stated in this application.
*
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Checkout
It's time to checkout! Select your number of registrations and choose how much camper cash your camper(s) will have during the week! You can pay in full now or you can choose to make a minimum deposit now and pay in full later.
Let's checkout! Will you pay in full or make a minimum deposit today?
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( X )
Camper Registration LATE
$
200.00
Please choose the quantity of registrations to match the number of campers registered on this form. If you pay in full you do NOT need to make a minimum deposit.
Quantity
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Item subtotal:
$
0.00
Minimum Deposit per Camper
$
75.00
If you cannot pay the full registration today, then you can choose to make a minimum deposit for each of the campers registered. Do NOT choose to make a "minimum deposit" and pay for the "camper registration" at the same time.
Quantity
0
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Camper Cash
$
12.00
This cash will go in our Camper Bank and it can be used for camp snacks and crafts. Most campers will spend $25 during the week. If your camper does not use the cash it will be donated to camp at the end of the week. There will be no refund given on camper cash.
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0.00
Enter coupon
Apply
Total
$
0.00
Payment Methods
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