2025 ABCCR Camping

Camper Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Birthday*

Date

Grade in the Fall*

Church*

Town*

Name of Youth Pastor or Leader*

First NameLast Name

Email of Youth Pastor or Leader*

example@example.com

Gender*

MaleFemale

Shirt Size*

Parent/ Guardian Name*

First NameLast Name

Parent/ Guardian Email*

example@example.com

Parent/ Guardian Phone Number*

Please enter a valid phone number.

List any allergies, including FOOD allergies or special needs for child*

List any physical or mental conditions that may affect your child at camp (example: bed wetting, ADHD, nightmares, disabilities). Please contact the camp director before completing the registration if your child has special needs to ensure we can accommodate them.*

Emergency Contact Name*

First NameLast Name

Emergency Contact Number*

Please enter a valid phone number.

Relationship to Participant*

Camp Christy Registration Costs

High School Camp- Before May 1, 2025 ($280) After May 1, 2025 ($300)

Middle School Camp- Before May 1, 2025 ($280) After May 1, 2025 ($300)

Junior Camp- Before May 1, 2025 ($280) After May 1, 2025 ($300)

Primary Camp- Before May 1, 2025 ($140) After May 1, 2025 ($150)

Day Camp- Before May 1, 2025 ($90) After May 1, 2025 ($100)

Camp Christy Registration Deadlines

High School Camp- May 19, 2025

Middle School Camp- May 26, 2025

Junior Camp- June 2, 2025

Primary Camp- June 9, 2025

Day Camp- June 9, 2025

No registrations will be accepted after the cutoff date.

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White Memorial Registration Costs

High School Camp- Before June 1, 2025 ($395) After June 1, 2025 ($415)

Middle School Camp- Before June 1, 2025 ($395) After June 1, 2025 ($415)

Junior Camp- Before June 1, 2025 ($395) After June 1, 2025 ($415)

White Memorial Registration Deadlines

High School Camp- June 30, 2025

Middle School Camp- June 30, 2025

Junior Camp- June 30, 2025

No registrations will be accepted after the cutoff date.

Which campsite do you want to attend?*

Camp Christy- Scott City, KSCamp White Memorial- Council Grove, KS

Select your Camp Christy Camp*

Select your White Memorial Camp*

How will you be paying?*

Online via Credit/ Debit CardSending a checkChurch pay

My Products

Camp Christy High School CampCamp Christy, June 2-6

$280.00

Camp Chirsty Middle School CampCamp Chirsty, June 9-13

$280.00

Camp Christy Junior CampCamp Christy, June 16-20

$280.00

Camp Christy Primary CampCamp Christy, June 23-25

$180.00

Camp Christy Day CampCamp Christy. June 26-27

$90.00

White Memorial High School CampWhite Memorial, July 14-18

$395.00

White Memorial Junior CampWhite Memorial, July 21-25

$395.00

White Memorial Middle School CampWhite Memorial, July 14-18

$395.00

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Discipline, Liability, Sickness, & Medical Release I , the parent or legal guardian of the participant listed on this form, certify that he/she has my full approval to participate in the event(s) listed above with the American Baptist Churches of the Central Region. The individual identified on this form understands that all participants are expected to abide by the program rules and be directly responsible to their church leader. The event director assumes responsibility for discipline at the program and, if necessary, may, because of misconduct or disobedience, require a participant to leave. In such instance, I will assume full responsibility for returning the participant home. Further, I do release and hereby agree to hold blameless ABCCR and its employees and agents from any and every claim arising, or which may be asserted by me or by any member of my family by reason of participating in any activities associated with ABCCR. I also release the lessor/owner of properties on which the Program is held. I agree to pay for any damages or property loss as determined by ABCCR .Further, I do authorize the minister or sponsor of this activity or any ABCCR staff member, in the event I cannot be reached by phone, to give consent to a physician and/or hospital for emergency medical or surgical treatment while on this trip. I will not hold ABCCR, Camp Christy, or Camp White Memorial at fault for any sickness or illness my child may contract while at camp. We will isolate sick students and if necessary parents will be contacted in order to remove their student from camp. It is understood that I will assume any financial responsibility for any expense that may be incurred for said emergency treatment. Further, I do certify that said participant is covered by adequate accident insurance. My consent and signature are given below. I have read and agree to the information given in this entire form.*

Financial Responsibility Covenant I, the parent or legal guardian of the participant listed on this form acknowledge my financial responsibility for the Participant's camp registration costs. I understand and agree that: All camp registrations that were not designated as "church pay" must be paid in full prior to the first day of camp. If payment is not received by this deadline, the American Baptist Churches of the Central Region (ABCCR) reserves the right to deny the Participant's participation in camp activities. If I have designated "church pay" as the payment method and the designated church does not remit payment in full, I will assume financial responsibility for the camp registration costs. I have also read and understand that the ABCCR's refund policy is as follows: Full refund up to 30 days prior to the first day of camp, half refund up to 14 days before camp, no refund will be issued after 14 days before camp. The ABCCR has the right to evaluate requests for exceptions on a case by case basis. *

Image Release I (We), the undersigned individual(s), grant American Baptist Churches of the Central Region (ABCCR), located at 5889 SW 29th St, Topeka, Kansas, USA, the perpetual, non-exclusive, royalty-free right and license to: Record my participation and appearance on digital or film photography, video, audio or any other medium. Use my name (or any fictional name), likeness, voice and biographical material and information in connection with these recordings to be used only in or for ABCCR written, electronic and web publications, including social media and apps to be used for the promotional material, multimedia and publication purposes of the American Baptist Churches or the Central Region. Reproduce, distribute, publicly display and/or publicly perform, in print, electronic or any other medium, copies of the recordings, in whole or in part. Grantor represents that he or she possesses all rights necessary to grant this permission for and in connection. I am voluntarily making this grant of rights. I further agree to release and forever discharge ABCCR, its agents, employees and designated representatives from any and all claims in law or equity that I, my heirs or personal representatives have or shall have arising out of recordings. I also consent to the use of my child's image by Camp Christy and Camp White Memorial. I am the parent or guardian of the minor named above and have the legal authority to execute the above release. I approve and waive any rights in this release. *

I give permission for my child/ self to be recorded in any form of media by ABCCR*

YesNo

Camp White Memorial Waiver The agreement is between the registered, participating, guest (Persons 18 years or older, or person's legal guardian must complete the form on behalf of the camper or guest attending an event) hereto referred to as 'PARTICIPANT' and White Memorial Camp, White Memorial Camp Management Group, Inc., its employees and associated parties hereto referred to as 'WMC'. Release of Liability/Assumption of Risk: In consideration of 'PARTICIPANT' being permitted by WMC. to participate in its activities and to use its equipment and facilities, I further agree to indemnify and hold harmless WMC, its employees and associated parties from any and all claims which are brought by, or on behalf of Minor, and which are in any way connected with such use or participation by 'PARTICIPANT.' I assume full responsibility for 'PARTICIPANT' health being such that the activities will in no way aggravate any conditions present. WMC will be notified of any changes 'PARTICIPANT' health status prior to the activity/trip departure. I declare the statements on this form to be true. I, PARTICIPANT, hereby release, discharge and agree to indemnify and hold WMC harmless from, and waive on behalf of myself, my heirs and successors, any and all causes of action, claims, demands, damage, costs, expenses and compensation or loss to myself that may be caused by any act, or failure to act of WMC, or that may otherwise arise in any way in connection with any activities with, or at WMC. I, PARTICIPANT, understand that this release discharges WMC from any liability or claim that I may have against WMC with respect to any bodily injury, illness, or death that may arise from or in connection with my activities. This liability waiver and release extends to WMC together with all its Board of Directors, all parent or member entities and their Board of Directors, all affiliated entities and their Board of Directors, and employees. By signing below, I voluntarily agree to comply with the written instructions above and the assumption of risk and waiver of liability. Failure to comply with these written instructions or verbal instructions from staff may result in my privileges being removed and Imay be asked to leave the premises Permission to Search: If necessary, WMC staff, with approval from Camp Director and User Camp Representative, may search PARTICIPANT’s belongings with a witness present only when the health, well-being, or safety of the camper or others requires it. Parents/Guardians will be notified if a search takes place. Challenge Course Acknowledgement and Assumption of Risk: Unless otherwise stated in writing or included in Health Forms submitted to WMC, I acknowledge that ‘PARTICIPANT’ is permitted to utilize the WMC Challenge Course. Agreeing below acknowledges that during this challenge course experience, certain dangers and risks may occur. These include, but are not limited to, the dangers of being at heights of up to 50 feet above the ground, damage to personal property, physical or psychological damage, and/or injury, not excluding fatality, due to accidents that may occur and/or result from participating in this challenge course activity. PARTICIPANT understands that while participating in this challenge course they will be subjected to elements of nature including inclement weather and varying temperatures. PARTICIPANT acknowledges the weight limit for the high ropes and zip-line events to be 250 lbs. PARTICIPANT will notify WMC facilitators of limitations they should be aware of which may hinder participation in this activity. However, PARTICIPANT understand that it is solely their responsibility to determine whether there is any medical reason that they should not participate in this activity. COVID 19 Risk, Policies, and Waiver of Liability: I, PARTICIPANT, hereby acknowledge that WMC has implemented certain policies, procedures, and processes to protect its workers, participants, visitors, and volunteers from the acquisition and spread of COVID 19. To this extent, I agree to follow all WMC policies, procedures, and processes as well as any Center of Disease Control (CDC) and local public health guidelines to reduce the likelihood of acquiring or spreading of COVID 19.I, PARTICIPANT, acknowledge that I have voluntarily registered to attend WMC program and facilities. I understand that there is no compensation or direct medical health coverage afforded to me during my relationship with WMC and WMC is not responsible for any potential exposure to COVID 19. Due to the nature of COVID 19 I understand that even if I follow all policies, procedures, and processes I still may be exposed to COVID 19 and I may acquire COVID 19 through my participation in a program at WMC. I fully understand and appreciate the risks that are inherent to my activities at WMC, including but not limited to the risk of exposure to COVID 19. I, PARTICIPANT, hereby assume the risk of bodily injury, illness, and death resulting from my activities even if resulting from the negligence of WMC or its employees, volunteers, patients, or visitors. I understand that certain inherent factors may make me more susceptible to acquiring COVID 19 or may increase the likelihood of severe symptoms, including death, if I contract COVID 19, and I have taken such factors into consideration and discussed any concerns with my physician(s) prior to participating in a WMC experience at the WMC property. Media Release: I grant permission to White Memorial Camp, its agents, and its employees the irrevocable and unrestricted right to produce photographs and video taken of my child, myself, and members of my family while at White Memorial Camp for any lawful purpose including publication, promotion, illustration, advertising, trade, or historical archive in any manner or in any medium. I hereby release White Memorial Camp and its legal representatives from liability for any violation or claims relating to said images or video. Furthermore, I grant permission to use the statements of my child, myself, or my family members given during an interview or evaluation with or without my name for the purpose of advertising and publicity without restriction to time limit or geographic area. I waive my right, my child's rights, and my family's rights to any and all compensation stemming from the use of these materials. To help protect our campers and guests, White Memorial Camp will not identify campers or guests in its social media or other media posting sunless the person or their legal guardian requests in writing that their camper be identified in such media Swimming Notice: I acknowledge that unless prior arrangements were made, there will be no lifeguard or instructors on site for activities White Memorial Camp; 1271 S. 1050 Rd. Council Grove, Ks 66846 620-767-5165 620-767-7244(fax) office@whitememorialcamp.com such as swimming in the pool and therefore I (and/or my minor) swim at my own risk. While in or on the lake myself/my child will use a life jacket. Permission to Treat and Medical Permission: Authorization to Provide Emergency Care: I understand that every reasonable effort will be made to contact me (Parent/Legal Guardian) at the contact information I have provided in the event of an emergency. If I cannot be reached at the contact information supplied, I hereby give permission to the physician selected by WMC, to hospitalize, secure treatment for, and to order injection, anesthesia, or surgery for PARTICIPANT. I give permission for the release of the Health Forms and Physicals as well as any accompanying information or medical records to medical professionals in the event of injury or illness. I give permission for PARTICIPANT to be transported by WMC to the necessary medical facility. Currently, this is Morris County Hospital. Authorization for Administration of Medication: I give permission for non-prescription medications to be given to my child by the camp’s health care manager, if deemed necessary. I give permission for any prescription medicines brought to camp by my child to be administered by the camp’s health care manager, who will administer the medication according to the directions on the pharmaceutical container, unless otherwise directed by a physician. Additionally, I understand that medications (prescription and non-prescription) brought by my child to camp will be turned over to and stored by the camp health care manager. I acknowledge and agree to the above statements and I will participate responsibly so as to make this a safe experience for all. All participants are required to sign the waiver in order to participate in any on-site event or activity. Minors (Under 18 years old) require Parent or Legal Guardian’s Signature in order to participate. *

Campers attending Camp Christy will need to complete the forms below.

Transportation/ Canoe Release

Medication Form

ABCCR Camping Registration 2025