West Bank Bible Camp 2023 Registration

2024 Summer Camp Registration
If you have received sponsorship, please fill out this registration and put the sponsorship information in the space at the end, then click "submit registration" without payment info.
Camper Information
Camper Name*

First NameLast Name
Once you select the campers age and biological gender, the available camps will be displayed below*
Camper age by end of 2024*
Biological Gender*

MaleFemale
Junior Camps (age 8-11) Male
Junior Camps (age 8-11) Female
Young Teen Camps (age 12-14) Male
Young Teen Camps (age 12-14) Female
Jr. Squirt Camp (age 6-7) Male
Jr. Squirt Camp (age 6-7) Female
Sr. Squirt Camp (age 7-8) Male
Sr. Squirt Camp (age 7-8) Female
Youth Retreat (age 15-18) Male
Youth Retreat (age 15-18) Female
Skill Selection

Please pick your top 5 skills selections with a different skill in each box. We will do our best to put the camper in their top 3 skill choices and put campers with their camper requests.

Skills with extra costs ($) have limited spots. They will take priority over the top 5 selected skills

#1 = Most Wanted
Junior 1 Horsemanship
Junior 2 Horsemanship
Junior 3 Horsemanship
Young Teen 1 Horsemanship
Young Teen 2 Horsemanship
Young Teen 1 Paintball
Young Teen 2 Paintball
Junior Skill Select #1
Junior Skill Select #2
Junior Skill Select #3
Junior Skill Select #4
Junior Skill Select #5
Young Teen Skill Select #1
Young Teen Skill Select #2
Young Teen Skill Select #3
Young Teen Skill Select #4
Young Teen Skill Select #5
Tuck Shop Candy

Part of the registration fee covers $2 of snacks per weekday for your camper from Haleys Hut.
Camper Request
If your camper has someone they would like to share a cabin with please put their name here and we will do our best to put them together.
Parent/Guardian Information
Name*

First NameLast Name
Home Number
Cell Number*
Email (Used for confirmation emails) *
example@example.com
Confirm Email *
example@example.com
EMAILS DO NOT MATCH!
EMAILS MATCH
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Church (if you have one)
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Alt. Phone Number
Medical Information
Camper Birthday

MonthDayYear
Date
Camper Health Card #*
Camper Weight (lb)*
Previous Medications
Current Medications
Please list any health concerns we should be aware of
Allergies and severity
Additional Health

AsthmaDiabetesFaintingTonsillitisConvulsionsBed Wetting
Permission to Give Medication*

YesNo
List of Allowed Medications*

ALLOW ALLTylenolAdvilGravolBenadrylRub A535Pepto BismolDimetappPolysporinFisherman's FriendsDeep Cold OintmentBenylin Cough SyrupTumsCamaline LotionVick's Vapour RubTylenol SinusMidol
Is there anything else the camp staff should be aware of in order to help us relate to, and better understand your child?
CAMP MERCH

Would you like to buy any camp merch for your camper?

SAVE $5 OFF if you purchase 1 or more items with a registration. Ordering now will also ensure your camper gets their item(s) instead of relying on remaining stock when you come to camp (plus no waiting in line).
Please Select Items you would like to purchase with your registration

STYLE #1 - Blue Shirt "Primary Logo" ($20)STYLE #2 - Blue Shirt "Letters Logo" ($20)STYLE #3 Black Tank Top "Primary Logo" (Adult Sizes Only) ($20)STYLE #4 Black Tank Top "Letters Logo" (Adult Sizes Only) ($20)Hat ($25)Blue Sport Bottle ($10)Sunglasses ($10)
Camp Merch Cost 1
-5
T-Shirt Size
Tank Top Size
Camp Merch Cost
-$5 automatically included
Jr. Squirt
Junior 1
Young Teen 1
Junior 2
Sr. Squirt
Young Teen 2
Junior 3
Youth Retreat
Day Camps
Horsemanship
Paintball
Informed Consent and Acknowledgement

Read before Signing

With regards to participation at West Bank Bible Camp (hereinafter called WBBC), I acknowledge, understand and agree:

1. Despite precautions taken by WBBC, personal injury or accident may occur through activity participation. These activities include, but are not limited to, paintball, horsemanship, climbing wall, swimming, canoeing, zipline, giant swing, laser tag, religious instruction, and other activities listed on the camp website. Through my signature on this form, I assume risks related to the use of any and all spaces used by WBBC.

2. To release WBBC from responsibility, including all staff, volunteers, and agents, and the facilities used from any cause of action, claims, or demands, now or in the future that might come from participation in activities at any point or from physical risks associated.

3. I accept all risks related to the such activities including personal injury, both major and minor, including death, may occur on camp premises. I understand these risks and will hold not WBBC liable for any such injury.

4. I also consent to WBBC staff transporting this participant in camp-owned vehicles for program-related activities or for required medical attention if contact with parents or listed emergency contact cannot be made and accept the risks involved.

5. I also consent to the use of any photograph or videos of this participant in future publications online or in promotional material for the camp.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
I acknowledge, understand and agree with the above informed consent and assumption of risk*
Date*

MonthDayYear
Date
Signature*

Clear
Signature Printed Name*
If you have received sponsorship, put the sponsorship information in the space below, then click "submit registration" without payment info.
Do you have a coupon or have received sponsorship?

YesNo
Who is the coupon/sponsorship from?
How much is the coupon/sponsorship worth?
What would you like to pay today?*

Full Amount$100 Registration Deposit + Extra Skill Costs + Camp Merch + Donation
Full Amount is required for Squirt Camps and Day Camps*
Registration 1
Registration
Extra Skill Costs
Camp Merch
Coupon
Donation (optional) We strive to keep camp affordable and you can help contribute to that. Donation Receipt available for gifts over $20.
TOTAL

Payment

CAD

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

2024 Summer Camp Registration