Camp Crossfire Registration

Camp CrossFire Application 2022
1. Instructions

Parents must apply for each child individually.
1. Provide your child's information.
2. Review the camp payment details.
3. Provide the camper checklist information.
4. Provide the camper's medical information.
5. Provide your information.
6. Click " Submit "button to agree to the registration requirements and reserve the slot.
7. Payments can be made on site by check, money order, or on-line via the website at http://crossfirecamp.org . Cash payments cannot be accepted.

2. Camp Session Dates

July 10-15 (Sunday check-in 3-5 pm; Friday closing ceremonies at 10:00 am)

3. Camper Information

Camper's Full Name *

First Name Last Name
Camper's Grade Completed *
Camper's Age *
Camper's Date of Birth *

Day Month Year
Camper's Gender *
Camper's Address *

Street Address

Street Address Line 2

City State

Postal / Zip Code
Home Phone No. *

Area Code Phone Number
Cell Phone No. *

Area Code Phone Number
Parent/Guardian Email Address *
T-Shirt Size *
Home Church *

4. Camper Fee Information

Total camp fee for the session is: $190.00

or a non-refundable deposit to hold a camper's reservation: $ 95.00

You may pay either the total fee or the deposit amount on-line at http://crossfirecamp.org, or may pay by mail using a personal check or a money order (payment MUST be received prior to July 4 to reserve a spot). Cash payments can not be accepted.
________________________________________________________________

To Be Completed by CrossFire Registration Staff Only

The amount due on or before opening day of camp is: $ ________ Initials: _____

The full amount of $190 has been paid for this camper: Initials: _____

Date a Deposit of $95 received: __________________ Initials: _____

This is a staff member. Initials: _____ .

Paid On-Line: ____ or Sponsored by: __________

________________________________________________________________
Select Payment Amount (use the Payment tab to pay on-line) *
Name of Person Who will be Paying for this Camper *

First Name Last Name
Camp CrossFire Staff

Each member of the staff of CrossFire Christian Camp is a faithful Christian from an area Church of Christ. Each staff member is required to complete a sensitivity and abuse training course. Each staff member submits to a Texas Department of Public Safety background check.
5. Camper Checklist
What to bring:
- good attitude
- Bible
- notebook, pen, or pencil
- bedding, sleeping bag, pillow
- toiletries, towels
- swimwear plus dark shirt
- clothing for five days, including clothes that can get wet
Camper Initials - what to bring *
Parent Initials - what to bring *
What NOT to bring:

firearms, knives, fireworks

illegal drugs, tobacco of any form, matches or lighters

valuables (jewelry, money, expensive gadjets)
Camper Initials: what not to bring *
Parent Initials: what not to bring *
For both campers and staff, male and female, all shorts worn must be no more than 4" above the knee. Skirts and blouses must have sleeves, cover the midriff, and have a modest neckline. The following articles of clothing will not be allowed at Camp CrossFire:
- Soffe shorts, short shorts, booty shorts
- tank tops, spagetti straps, muscle shirts
- see through clothing
- any clothing that is un-Christian in language or logo
Camper Initials: unsuitable attire *
Parent Initials: unsuitable attire *
Computers, cell phones, tablets, and related electronics must NOT be brought to camp. Only with special permission from the Cabin Counselor or Camp Director will an exception be approved. Camp CrossFire and its staff are not responsible for the loss or damage to electronics brought to camp.
Camper Initials: electronics at camp *
Parent Initials: electronics at camp *

6. Camper Medical Information

Camper's Name (Med) *

First Name Last Name
Camper's Address (Med) *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Last 4 Digits of Camper's SSN *
Camper's Date of Birth *

Day Month Year
Camper's Grade Completed (Med) *
Camper's Gender *
Home Church *
Parent's/Guardian's Full Name *
Parent's Address (Med) *

Street Address

Street Address Line 2

City State

Postal / Zip Code
Insurance Co. Name *
Name of the Insured *
Policy Number *
Name of Family Physician *
Physician's Office Phone *

Area Code Phone Number
Date of Most Recent DPT *
Date of Most Recent MMR *
Date of Most Recent Polio *
Date of Most Recent TB Skin Test *
Date of Most Recent Tetanus *
Date of Most Recent Other (specify)
List any any allergies your child has (e.g. to medications, food, environmental, and the type of reaction). Enter "None" if none. *
List any health conditions your child has (e.g. allergies and type reaction, asthma, diabetes, seizures, etc). Enter "None" if none. *
List any prescription medications that your child will need to take at camp (Note: both prescription and non-prescription medications your child brings to camp must be in the ORIGINAL CONTAINER and instructions for administration must be included). Enter "None" if none. *
Please list below any restrictions for your child's activities and/or any special supervision that is needed. Enter "None" if none. *
Name of First Emergency Contact *
Phone Number First Emergency Contact *

Area Code Phone Number
Name of Second Emergency Contact *
Phone Number Second Emergency Contact *

Area Code Phone Number
Camp personnel are on duty at all times to administer first aid for common non-emergency treatments. A hospital with emergency room facilitiesis also available for the camp. Please be specific and thorough about your camper's shots and/or medications. All medication that needs to be administered to a camper (both prescriptino and non-prescription) must be given to the designated camp personnel and must be in its original container, well identified, and have instructions for administration. The leaders of the rental group are responsible for securing any medical care needed by any member of the group while in attendance at Parrie Haynes Ranch.

I understand the risk of injury that can result from activities and/or services offered at Parrie Haynes Ranch. In consideration of acceptance for participation in same, I do voluntarily and knowingly execute this release, waiving all claims, action, demands or rights to monetary judgement from Parrie Haynes Ranch or its staff or the sponsors or the staff of CrossFire Camp for any and all injury, illness,, or physical harm which may arisefrom his or her atttendance at Parrie Haynes Ranch and/or participation in any program or activity sponsored by or supervised by any of the above.

In case of medical or surgical emergency, I hereby give permission to the physician selected by the rental group leaders to hospitalize, secure necessary treatment and to order injections, anesthesia or surgery as the physician may deem appropriate for my child named above. I agree that any charges for these services are my sole responsibility. In case medical treatment is needed at the local clinic or hospital, I authorize the camp leaders to transport my child in the manner in which their best judgement dictates.
Printed Name as Signature *
Date of Signature *

Month Day Year

7. Parent / Guardian's Details

Name of Person Completing this Application *

First Name Last Name
Physical Address *

Street Address, City, State

Street Address Line 2

City State

Zip Code
Your Relationship to Camper *
Your E-mail Address *
How did you hear about Camp CrossFire? *
If you need a copy of your completed registration, please click on the "Print Form" button below BEFORE clicking the "Submit" button.

By clicking the "Submit" button at the bottom of this form, I agree to the statements below:
- I confirm that I understand the refund policy for Camp CrossFire whereby fees once paid (for Camp CrossFire) are not refundable.
- I confirm that I understand that if payment for Camp CrossFire is not received by the first day of camp, my child will not not be permitted to participate.
- I give my permission to Camp CrossFire to use my child's photography/video in medium used for advertising purposes.
- I give my permission for my child to participate in activities sponsored by Camp CrossFire.
PLEASE NOTE: Campers must be residing with at least one parent/relative or parent approved care giver while enrolled for camp.
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Camp CrossFire Application 2022