2025 Staff Registration Form
Sponsor Information
Sponsor's Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
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31
Day
Please select a year
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
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1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Gender
*
Please Select
Female
Male
Specify Camp(s):
Junior Camp
Middle School
High School
Representing (Church or College)
*
Training/Teaching Experience/Education/Special Licenses (CPR, First Aid, etc.)
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Parent Information (if sponsor is under 18)
Parent/Guardian Name
First Name
Last Name
Relationship to Sponsor?
Parent/Guardian Phone Number
Please enter a valid phone number.
Emergency Contact Information
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Relationship to Sponsor?
*
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Reference
Please provide a reference from your Home/Sponsoring church.
Reference Name
*
First Name
Last Name
Title
*
Reference's Phone Number
*
Please enter a valid phone number.
Medical Release:
In case of emergency, I understand that every effort will be made to contact the Emergency Contact previously named. In the event he/she cannot be reached, I hereby give permission to the physician selected by the camp nurse or director to hospitalize and secure proper treatment (including surgery).
Signature
*
Do you have any allergies (food or environmental) that we should be aware of?
*
NO
YES
If YES, please explain
*
Do you have any special dietary needs?
*
NO
YES
If YES, please explain:
*
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Media Release
Individual and group photos taken at camp may be used in any or all forms of media for advertising. The names of the campers/sponsors will not be used if photos are placed on our website or other social media websites. By signing below I give permission for Camp Christian to take /use photos of myself or child for advertising and media purposes. Leave blank if no such permission is given.
Signature:
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Child Abuse Statement:
I hereby state that I have never been convicted of any felony, child abuse, or unlawful sexual offense.
Signature
*
Background Check:
*
I have a current (performed in the past 5 years) background check report on file with my home church.
I do NOT have a current background check report but will complete the consent form (provided by camp) 5 days prior to camp.
Perjury Statement:
Any staff member or volunteer who knowingly or willfully makes a false statement of any material fact in the registration process is guilty of perjury in the second degree and upon conviction thereof, shall be punished accordingly.
Printed Name
*
First Name
Last Name
Signature
*
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Camp shirts with the "Built for Worship" theme will be on sale at camp for $20. If you will be purchasing one, please indicating their size below.
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult X-Large
Adult 2X-Large
Adult 3X-Large
Submit
Should be Empty: