SCBN Day Camp Discover 2024

South Central Baptist Network

Day Camp Application 2024

Registration deadline is June 14, 2024

All fields marked with * are required and must be completed.

June 24-27. For boys and girls ages 5-7.

Cost is $75.00

Day camp is Monday - Thursday, 8:30 AM - 4:30 PM
Children need to bring a swimsuit, towel, sunscreen, plastic bag for wet clothes and flip flops/pool shoes
Children should not bring cellphones or other electronic devices
All campers should be preregistered and prepaid in order for registration to be considered complete. Payment should be received in the office by June 10th.

Camper Name*

First NameLast Name

Camper's Address*

Street Address

Street Address Line 2

CityState

Zip Code

Date of Birth*

Date

5 years old6 years old7 years oldOther

Biological Sex*

What church does Camper attend?

YESNO

Does Camper have permission to swim?*

Please provide swim aids if needed

NoBeginning SwimmerYesOther

Camper's parent or guardian:*

Primary Parent's First & Last Name

Address if different than Camper*

If address is the same, type "SAME"

Primary Contact's Number*

Primary or cell numberFormat: (000) 000-0000.

Primary Contact's Additional Phone Number

Work, Landline, etcFormat: (000) 000-0000.

Primary Contact's Email

example@example.com

Secondary person to call if parent or guardian cannot be reached

Secondary Contact's Phone Number

Primary or Cell NumberFormat: (000) 000-0000.

EMERGENCY CONTACT*

Name & Relationship

Emergency Contact's Phone Number*

Primary or Cell NumberFormat: (000) 000-0000.

YESNO

Van transportation to camp will depart promptly at 8:00 AM from the parking lot on the corner of 5th Street & 13th Avenue (previous location of the Cordele First Baptist Church parking lot). The bus will return for pickup at 4:45 pm.

Campers Name*

Camper's Physician's Name*

If none, type "NONE"

Physician's Phone Number

Format: (000) 000-0000.

List any and all allergies (including food), medical problems, or physical limitations Camper has: (if none, indicate "NONE")*

Example: Allergic to bee stings, Must carry Epi pen or Asthma, may need inhaler

Does Camper currently take any medication?*

If yes, please use the section below to list all medications.

List all medications and dosage Camper is currently taking:*

If none, type "NONE". For any prescription medication the camper is currently taking, it must be in its original container.

Does Camper have a special diet that needs to be followed?*

If yes, you will need to provide the SPECIAL FOOD your camper needs.

Can we administer basic first aid to your child as needed?*

You will receive a call from us for anything beyond basic first aid.

Your child may receive the following for pain or fever:*

If your child has a need for acetaminophen (ex. Tylenol) or ibuprofen (ex. Advil), would you like a phone call before it is given to him or her?*

Is there any additional medical information we should know about your child?

MEDICAL PERMISSION & ACKNOWLEDGEMENTS: My child has my concent to attend the South Central Baptist Network (SCBN) Camp. I acknowledge that my child's experience at the SCBN Children's Day Camp will be outdoors, often in direct sun with minimal shade, and around wooded areas. I understand there is a chance my child may come into contact with the following hazards included (but not limited to): ants, mosquitos, ticks, chiggers, poison oak / ivy, wasps, and bees. I further acknowledge that SCBN Camp and its staff are not responsible for any bug bites, sunburns or possible illnesses, including COVID-19, that may result from my child participating in activities while on the SCBN Camp premises. I further certify that to my knowledge, my child has not been exposed to any contagious diseases within the last thirty days. My signature below authorizes the staff at the SCBN Camp to request emergency treatment for my child if the situation warrants and I am unable to be contacted.

PHOTO RELEASE: I understand that my child may be photographed or videotaped while participating in the activities at the SCBN Camp. South Central Baptist Network Association has my permission to use these pictures in promotional material and/or on the Association website/social media pages. I understand that no identifying information will be provided with the photos.

YOUR CHILD'S REGISTRATION IS NOT CONSIDERED COMPLETE UNTIL PAYMENT HAS BEEN RECEIVED IN OUR OFFICE.

Parent/Guardians name printed*

Parent/Guardians signature*

Date

Payments can be made by coming to the office or by mail.

Your child is not considered fully registered until we receive a completed application AND payment.

Office Physical Address: 2116 US Highway 41 North, Cordele, GA 31015

Office Mailing Address: PO Box 1274, Cordele, GA 31010

If you are paying by check, make it payable to "South Central Baptist Network" and indicate Camper's name(s) on the check.

Partial scholarships are available if there is a financial hardship.

Camp Discover

Medical Release Form