Camper Information
Camper's Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Gender
*
Male
Female
Grade Entering in the Fall
*
Please Select
K
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Camper Lives With:
*
Please Select
Both Parents
Legal Guardian
Mother Only
Father Only
Foster Parent(s)
Other
Camper's Physical Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Church Attending With:
*
Camper's First Time at WCCSC?
*
Please Select
Yes
No
Are there any persons who are NOT ALLOWED to visit your child during camp? If yes, please list them and their relationship:
*
Campers in grades K-8th grades must be signed out by an authorized adult at the end of the week. Please List the names and relationships of any adults authorized to pick up your camper.
*
This includes any member of your church's ministry.
Parent / Guardian Information
When and where appropriate, please type "N/A" (not applicable) in the appropriate box and use zeros for that phone number. Thank you!
Mother's Name
*
First Name
Last Name
Mother's Phone Number
*
Please enter a valid phone number.
Mother's Email
*
example@example.com
Father's Name
*
First Name
Last Name
Father's Phone Number
*
Please enter a valid phone number.
Father's Email
*
example@example.com
Legal Guardian's Name *Leave blank if same as parent
First Name
Last Name
Legal Guardian's Phone
Please enter a valid phone number.
Legal Guardian's Email
example@example.com
Medical Information
The Medical Record must be filled out and signed by a parent/guardian for a camper to attend camp!
Camper's Name
*
First Name
Last Name
Year of last Tetanus shot:
*
If unknown, a shot may be given in the event of an emergency.
Does the camper have any medical conditions that the camp should be aware of?
*
Asthma, Heart Condition, etc.
Does the camper have any non-food allergies?
*
Is the camper allergic to any medications?
*
Please list any medications the camper is currently taking or may have in their possession. ALL medication must be turned in to the camp at the time of registration/check-in. It must be in the original container with the camper's name, medication name, dosage, etc. on the bottle.
*
Insurance Company:
*
Family Physician:
*
Physician Phone Number:
*
Please enter a valid phone number.
Emergency Contacts
Emergency Contact #1
*
First Name
Last Name
Relationship to Camper:
*
Emergency Contact #1 Phone:
*
Please enter a valid phone number.
Emergency Contact #2
*
First Name
Last Name
Relationship to Camper:
*
Emergency Contact #2 Phone:
*
Please enter a valid phone number.
Acknowledgements & Signature
WCCSC Rules
1] The Dean of each week is responsible for, and has authority over, everything during his week. Only the Camp Managers or a Board quorum can override his decisions. The dean has the authority to dismiss any faculty member or camper for violation of camp policy. 2] Every person is required to conform to the daily camp schedule. 3] Tobacco, alcohol, illegal drugs, vaping, or crude, obscene language is forbidden. 4] No one is allowed to leave the camp grounds without the permission of the dean. Campers must have a permission slip signed by their parent or guardian to leave the grounds. No field trips off camp grounds are allowed except to visit Show Me Christian Youth Home next door. 5] Sickness and injury should be reported to the camp medic immediately. 6] Males & females are forbidden to enter each other’s dorms and designated areas at any time. No one is allowed out of the dorms after lights out without permission from the dean. 7] Campers are not allowed to bring fans, fireworks, weapons, any entertainment electronics (CD players, games, etc) cell phones, bikes or skate boards. These items will be confiscated and returned at the end of the week. Music amps are only allowed in the chapel building. 8] Modest dress is required by all attending camp. Two-piece bathing suits showing a bare midriff are not allowed, nor are short-shorts (shorts must extend to the length of the wearer's fingertips), tube tops, spaghetti straps, clothing showing bare midriff, clothing displaying immoral slogans, pix, etc. Males are to wear shirts at all times except when swimming. Any faculty has the authority to ask campers to change into more appropriate clothing. 9] Visitors hours are from 5:00 pm 9:00 pm. Gates are locked for the night around 9:30 pm. Exceptions can be made for parents and special activities such as baptisms. All visitors are required to abide by all camp rules and schedules. They must sign in at the dining hall immediately upon arrival and receive a “visitor pass” to be worn at all times while on the grounds. 10] All camper’s automobiles will be parked in designated areas and keys turned into the camp office for the duration of the week. 11] Everyone is required to follow the pool rules and the Life Guard on duty has authority over all campers & faculty during swim times. 12] No food, gum, or bottled water is to be brought to camp by campers. No food or drink, except bottled water, is allowed in the dorms!! 13] Campers may be held financially responsible for any vandalism or damage to camp property. 14] WCCSC reserves the right to refuse admission to anyone, and reserves the right to expel any faculty or camper found to be living a lifestyle, or promoting any lifestyle, that the Directors of WCCSC believes to be in conflict with New Testament teaching on Christian behavior or doctrine. Bigotry and bullying are not acceptable as Christian behavior and will be disciplined accordingly.
WCCSC Rules
*
I have read and agree to the WCCSC Rules listed below. I will also read these rules to my child/camper.
Photo Release: WCCSC assumes the right to use photos and/or videos taken by camp staff wherein your child appears for official camp promotion in print brochures, website, and social media. Requests may be made in writing to the Camp Manager prior to the camper attending to have them excluded from photos or videos for the above stated purpose.
*
I agree to allow my pictures of my child to be used as stated above.
Refund Policy: Only 1/2 of registration fee will be refunded and must be requested at least 1 week ahead of camper's arrival date.
*
I agree to the WCCSC's Refund Policy
Camper's Fees: Parents/Guardians are responsible to pay registration and canteen in full when camper arrives.
*
I understand that I am responsible for my camper's camp fees.
Camper Cell Phone Policy: All cell phones that are brought to camp will be collected at registration and put in a safe to be distributed at the end of the week. Please do not encourage your student to keep or hide their cell phone. Campers may be sent home if found to have their phone that was not turned in.
*
I understand the WCCSC's Camper Cell Phone Policy
Illness Policy: I understand that any interaction with the general public poses an inherent risk of exposure to illness. By sending my camper to West Central Christian Service Camp, I am voluntarily assuming all risks related to exposure. I understand that the risks of injury and illness (ex: communicable diseases such as MRSA, influenza, and COVID) to my child from the activities involved in this program could be considered significant.
*
I understand the WCCSC's Illness Policy
Signature: By signing below, I hereby agree to the WCCSC Rules and acknowledgement listed above and give permission for this camper to attend WCCSC and will in no way hold the camp responsible for any accident that might befall the camper caused by negligence or disobedience on the camper's part. I give permission to the designated camp medical personnel (WCCSC does not have a certified doctor or nurse on staff) to administer camper meds, OTC drugs, or first aid as they deem necessary. In an emergency, camp personnel may choose a doctor and hospital to care for any serious accident or illness and will make normal efforts to contact me as soon as possible. Child attends at their own risk. WCCSC carries a $5,000 secondary policy on campers. Camper's insurance company will be billed first for any medical treatment
*
Name of the Person Completing this Form
*
First Name
Last Name
*
I CERTIFY THAT I AM THE LEGAL PARENT/GUARDIAN OF THIS CAMPER
Date if Signature:
*
-
Month
-
Day
Year
Date
My Products
prev
next
( X )
Day Camp Registration
July 12th
$
45.00
T-Shirt Store
2025 Camp T-Shirt
$
12.00
Size
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult X-Large
Adult XXL
Canteen
Campers can choose 1 drink and 1 snack item per canteen. If you would like to purchase your camper's canteen with your registration, please choose the correct week for your registration. Canteen money may also be added upon arrival.
$
5.00
Camp Week
Day Camp
2nd-3rd
3rd - 4th
4th - 5th
Jr. High / Sr. High
Item subtotal:
$
0.00
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
Continue
Continue
Should be Empty: