CrossView Christian Camp and Retreat Center
2024 Summer Camp Registration Form/Medical and Liability Release
Sign Releases
Angel Tree Camp Registration
Camper's Name
*
First Name
Last Name
Parent/ Guardian of Minor Camper signature
*
Relationship to Camper (minor)
*
Today's Date
*
-
Month
-
Day
Year
Date
Signed (Parent/Guardian of Minor Camper) :
*
Today's Date
*
-
Month
-
Day
Year
Date
2024 Summer Camp Registration Form
Camper's Legal Name
*
First Name
Last Name
Camper's Nickname
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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Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
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2015
2014
2013
2012
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1927
1926
1925
1924
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1920
Year
Age
*
Grade going into next fall
*
Select Camp Date
*
Please Select
Angel Tree Elementary (ages 7-12) July 22-25
Middle School (ages 12-14) June 24-28
High School (ages 15-18) July 15-19)
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
T-shirt Size
*
Please Select
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult XL
Adult 2XL
Adult 3XL
What is this child's race?
*
Caucasian
Hispanic
African-American
Asian
American Indian
Other
Medical Information
Camper's Height/ Weight
*
Date of Last Tetanus
*
-
Month
-
Day
Year
Date
Chronic Conditions:
*
Recent Surgery:
*
Medications & Dosages currently taking:
*
Please list ALL current medications and dosages
Bedwetter?
*
yes
no
Bladder/ Bowel Problems?
*
yes
no
If yes, please explain:
Please list all allergies (drug/ food/ bee stings/ etc)
*
Health Insurance Company
*
Policy #
*
This child has all the vaccinations required to attend a Texas Public School.
*
yes
no
Hospital Preference
*
Physician Name:
*
First Name
Last Name
Physician Phone #:
*
Please enter a valid phone number.
Learning & Behavior Information
Please list any and all Learning Disabilities, Behavioral Problems, and/or Mental Health Diagnoses
*
i.e. Dyslexia, ADD, ADHD, Depression, Runaway, Bipolar, Anxiety, Autism, OCD, Eating Disorder, etc.
Has this child been retained in a grade at least once?
*
yes
no
Is this participant on probation?
*
yes
no
If yes, for what crime and what are the terms of probation?
If yes, what is the level of his/her care:
Was/ is this child in residential treatment?
*
yes
no
If yes, when/ why?
Other helpful information we should know about this child:
*
Parent/Guardian Information
Parent/ Guardian Name
*
First Name
Last Name
Parent/Guardian Cell Number
*
Parent/Guardian E-mail **This is the email the we will use to communicate with you.
*
example@example.com
Emergency Information
Emergency Contact's Name
*
First Name
Last Name
Relationship
*
Please Select
Mother
Father
Grandparent
Aunt
Uncle
Other
Phone Number
*
Alt. Phone Number
*
An opportunity for water baptism will be presented during your child’s week of Camp. Every person baptized at CrossView receives a signed “baptism letter” with a color picture of their baptism. In the event your child expresses an interest, do you give your consent for him/her to be baptized?
*
yes
no
Household Information
Is this child in foster care?
*
yes
no
Has this child ever been in foster care?
*
yes
no
Is this child a "sibling" of foster child(ren)?
*
yes
no
Number of people living in this child's household:
*
What is this child's family situation:
*
Please Select
2 parent
single parent
step parent
grandparent
foster care
other
Are any adults in this household unemployed?
*
yes
no
Angel Tree Information
Are either of this child's parents currently incarcerated (even if a non-custodial parent)?
*
yes
no
Are there any children living in the same household of this child whose parents are incarcerated?
*
Yes
No
Name of Incarcerated Parent (Put N/A if none)
*
Name of facility in which parent is incarcerated (Put N/A if not applicable)
*
Has this child ever been enrolled in an Alternative Education Program (such as Project Intercept)?
*
yes
no
I certify that the above information is true and correct to the best of my knowledge.
*
Today's Date
*
-
Month
-
Day
Year
Date
Submit Form
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