Middle School Camp

Middle School Camp Registration
CAMPER INFORMATION:
Camper's Name*

First NameLast Name
Gender At Birth*

MaleFemale
Date of Birth*

MonthDayYear
Grade Entering In Fall*
Mailing Address*
City/State/Zip*
Has the child been baptized by immersion?

YesNo
Name of Church*
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name*

First NameLast Name
Mailing Address*
City, State, Zip*
Primary Phone Number*
Please enter a valid phone number.
Secondary Phone Number*
Please enter a valid phone number.
E-mail*
example@example.com
Emergency Contact

If Parent/guardian cannot be reached in emergency contact:
Emergency Contact Name*

First NameLast Name
Emergency Contact Number*

Area CodePhone Number
Relationship To Camper*
MEDICAL INFORMATION
Physician Name

First NameLast Name
Phone Number
Medical Concerns*

MEDICAL INFORMATION
Insurance Carrier*
Policy Holder*
Policy Number*
Group Number*
Will Camper be bringing any Medications to camp? (if yes please list below)*

YesNo
List Over Medications Camper Will Be Bring To Camp
List Over The Counter Medications Camp Cannot Take
List All Medical Allergies
List All Food Allergies

Camp Policies
Authorization To Attend Camp
DISCOUNT CODE IMPORTANT INFORMATION: PLEASE READ

Please call the camp office for discount code @ 352-535-3877. We offer 2 discounts, sibling and member church.

1.) Sibling discount apply to housholds that are registering more than 1 child regardless of weeks. The first child is full price and any other child can receive a 10% discount off their registration. This discount only applys to the camp week amount. Does not apply to tee shirts, canteen or mission.

2.) Member Church Discount is for families that are associated with a Member Church of the camp. Please contact someone in your church to see if this applies to you.
I authorize Tri State Christian Camp to render first aid treatment if needed. In case of emergency, I give permission to the camp to secure treatment for my child. I understand that every effort will be made to contact me before medical treatment is administered. I release the camp staff, faculty, officers, and management from liability. I also understand that the camp accident insurance is secondary to my own. I authorize participation in all camp activities and give permission for any photos or video taken during camp to be used for promotional purposes.

I understand that by registering my child for camp I am responsible for all charges above. If I have placed a deposit only on this registration I will ensure that the balance is paid in full on or before check-in of camper for their event.

ILLNESS POLICY:
I understand that any interaction with the general public poses an inherent risk of exposure to illness. By sending my camper Tri State Christian Camp, I am voluntarily assuming all risks related to exposure. I understand that the risks of injury and illness (ex: communicable diseases such as MRSA, influenza, and COVID) to my child from the activities involved in this program could be considered significant; and,

FOR MYSELF, SPOUSE, AND CHILD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS both known and unknown, and assume full responsibility for my child's participation; and, willingly agree to comply with the program's stated and customary terms and conditions for participation. I myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Tri State Christian Camp, its directors, officers, officials, agents, employees, volunteers and other participants, with respect to any and all injury, illness, disability, death, or loss /damage to person or property incident to the fullest extent permitted by law. Additionally, I HEREBY INDEMNIFY AND HOLD HARMLESS all the above from any and all liabilities to the fullest extent permitted by law.

I, FOR MYSELF, MY SPOUSE, AND MY CHILD/WARD, HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT WE HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
Terms Of Attending

Must agree to the following terms by selecting "I Agree " Option Below.
I Agree To and understand Above Terms.*

I Agree
Ad Lietem & Angel Tree Campers
If your child qualifies for Guardian Ad Litem or Angel Tree discounts please call Phil @ 352-535-3877 and leave a message and I will provide you with the code to bypass the registration fees.
PLEASE ONLY SELECT 1 OPTION, FULL AMOUNT OR DEPOSIT. DO NOT SELECT BOTH AS IT WILL REQUIRE A REFUND OF THE DEPOSIT MINUS PROCESS FEES.

Camper Fees*

Middle School Camp

$236.00 Quantity
Item subtotal:$0.00

Member Church Camper

$210.00

DepositBalance due at check-in.

$26.00

Camp T Shirt

$15.50 QuantitySize
Item subtotal:$0.00

Canteen

$6.00 Quantity
Item subtotal:$0.00

Enter coupon

Total

$0.00

Credit Card

Should be Empty:

Middle School Camp Registration

CAMPER INFORMATION:

PARENT/GUARDIAN INFORMATION:

Emergency Contact

MEDICAL INFORMATION

MEDICAL INFORMATION

Camp Policies

Authorization To Attend Camp

Terms Of Attending

Ad Lietem & Angel Tree Campers

Credit Card