SWCC Camp Registration 2023

Pre-Teen and Teen Camp CAMPER REGISTRATION FORM
Which Camp is your child attending?*
Camper's Name*

First NameLast Name
Gender*

MF
Phone Number*
Email Address*
example@example.com
Address*

Address

Street Address Line 2

City/State/ZipState / Province

Postal / Zip Code
Grade Completed (if student)*
Age*
Birthdate*

MonthDayYear
Date
Church*
Church City
T-Shirt Size*

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EMERGENCY CONTACT INFORMATION
Name (1)*
Relationship to Camper*
Phone*
Alternate Phone
Name (2)*
Relationship to Camper*
Phone*
Alternate Phone
Is camper current on all immunizations?*

YesNo
List relevant medical history/conditions that would help us meet the camper's needs:
Known allergies*
If None, type none.
Current medications*
If None, type none.
Is the student presently under a doctor's care?

YesNo
Doctor's Name
Doctor's Phone Number
Doctor's Address

Address

Street Address Line 2

City/State/ZipState / Province

Postal / Zip Code
Any special instructions
Parent/Guardian Name*
Parent Signature*

Clear
Date*

MonthDayYear
Date
AFCC RELEASE OF LIABILITY FORM
Parent Name*
Student Name*
Name of Camper*
Camper Signature*

Clear
Date*

MonthDayYear
Date
If the participant is younger than 18 then his/her parent or legal guardian must sign where indicated below. I am the Parent or Guardian of the aforementioned minor camper, and I verify by this signature the legal right to sign on behalf of the minor.
Name of Parent or Guardian*
Signature of Parent or Guardian*

Clear
Date*

MonthDayYear
Date
FOOD ALLERGY & SPECIAL DIET NEEDS

(Only Fill out if Necessary)
Does your child have food allergy or special diet needs?

YesNo
Camper Name
Age
Church
Parent's Name
Phone
Adult Sponsor
Adult Sponsor Phone Number
List FOOD allergies or explain special dietary needs
Is camper aware of his/her allergies?
Is camper able to monitor his/her own food requirements?
Walk on Water
Agreement to Participation
Assumption of Risk and Release of Liability
PLEASE READ BEFORE SIGNING
Signature of Participant (If Under 18, Parent or guardian must sign)*

Clear
Date*

MonthDayYear
Date
Name of Participant*
Payment
How much would you like to pay:*

Deposit PreTeen: $50 (nonrefundable)PreTeen: Full Payment $325Deposit Teen: $50 (nonrefundable)Teen: Full Payment $325
I would like to set up the following payment plan to pay the remaining balance:*
(This will not be put on automatic draft, just when reminders will be sent for unpaid balances)
Total
How Much would you like to pay towards your students camp?*

prevnext( X )
USDIf you do not have PayPal, click the paypal button and it will slow you to pay as guest and use your debit/credit card.
PreTeen and Teen camp are both now full , you can add your child to the waitlist and the spots will be filled in the order they are recieved .

WAITLIST SWCC Camp Registration

Any questions:

Teen Camp - John Henry 903.258.2227

PreTeen Camp - Mallan 903.738.3728

Should be Empty:

First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Pre-Teen and Teen Camp CAMPER REGISTRATION FORM

EMERGENCY CONTACT INFORMATION

AFCC RELEASE OF LIABILITY FORM

FOOD ALLERGY & SPECIAL DIET NEEDS

Payment