2026 Session TWO Registration Form

Camp Mission Summer Camp Registration

MUST BE FILLED OUT BY PARENT/LEGAL GUARDIAN
Session 2 - Tuesday, June 23-Saturday, June 27

6th - 12th grade
Camper Information
Last Name
First Name
Middle Name
Gender
Camper Tshirt Size (This is for the white craft tye-dye shirt)
Camper's Information
Address
City
State
Zip
Home Phone

Area CodePhone Number
Emergency Contact Name(if parent or guardian is not available)
Emergency Number

Area CodePhone Number
Birth Date

MonthDayYear
Grade entering in the fall
Cabin Buddy

List first and second choice, not all requests are guaranteed.
Cabin Buddy #1
Cabin Buddy #2
Parent or Legal Guardian Information
Parent/Legal Guardian
Relation
Cell Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
Parent /Legal Guardian 2
Relation 2
Cell Phone 2

Area CodePhone Number
Work Phone 2

Area CodePhone Number
Church Information
Church you attend (if any)
Church City
Church you are coming with (if any)
Email Confirmation
Parents Email (camper confirmation will be sent by email, if left blank it will be mailed)
Camper's Email
Other Information
First Time Camper?
Did you attend Camp Mission last year?
How did you hear about Camp Mission?
Health Information
It is our policy to contact the parent or guardian as soon as possible in the event of a serious accident or injury. Please bring all medication in Origional CONTAINER or you will not be allowed to leave the medication or vitamins at the camp. No exceptions. All prescriptions must be in that campers name and the correct dosage.
Camper Medical Insurance Provider
Medical Insurance Carrier Name
Medical Insurance Group Number
Medical Insurance Phone
Family Doctor
Family Doctor Phone Number
Preferred Hospital/Facility for Emergency Medical Services
Is camper free from infectious disease or conditions?
Are immunizations up to date?
Date of last tetanus shot
All fileds are required below. If nothing applies, please put "NONE" in the box.
Any activity the camper should be restricted from?
Any physical, mental or other condition that would require special attention or medication while at camp?
List any past medical treatment that would be helpful for us to know.
List any allergies (ex: bees,peanuts, dairy)
Any dietary needs that we should know about?
List all medications, both prescribed and over the counter, all medications will be turned into the health officer except rescue inhalers, bring all medication in original containers.
Parent & Camper Acknowledgements
Do we have permission to post pictures/videos to Camp Mission Social Media accounts?
Does your camper have your permission to swim in the lake?
Does your camper have permission to participate in all camp Mission's activities, sports, & programs?
By Initialing below, you agree that your child will not bring any electronic devices, cell phones, ipods, ipads, tablets, etc.
A Camp phone will be available all week for parents to call, and for campers to call home if needed.
By Initialing below, you acknowledge that you have read the camp rules (found on missiontoministry.org) with your camper and have agreed they will abide by the rules while on campus. You also agree that if your camper breaks the rules, you will come and pick them up should the directors feel the need to dismiss the camper early.
Please click on here to read Camp Mission Rules.
Camper Release
Camper Release (List anyone, including parents, to whom your camper can be released)
By hitting submit and signing your name, you agree that you are the parent or legal guardian of the above named camper, and are over the age of 18.

In case of medical emergency or general medical care, I give consent for medical teatment for the aboved named camper by authorized personnel at Camp Mission, Mission to Ministry, and YCL Ministries & Campground. I understand that the above named camper will only be released to the names listed above, and any update may be done at registration. I certify that my child has my permission to attend camp and participate in church services, camp activities, camp sports and all that Camp mission has to offer. I authorize Camp Mission, Mission to Ministry, YCL Ministries and Campground to use my camper's picture, testimony, and video in any promotional material(web,print,or media) My child may recieve any e-mails from the camp.
Signature

Camp Mission Summer Camp Registration

Session 2 - Tuesday, June 23-Saturday, June 27

Camper Information

Camper's Information

Cabin Buddy

Parent or Legal Guardian Information

Church Information

Email Confirmation

Other Information

Health Information

Parent & Camper Acknowledgements

Camper Release

Payment Information