Camp Jabez 2025

Name

First NameLast Name

Age (As of August 1, 2025)

Age

Date of Birth

Date of birth Month/ Day/ Year

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Main Contact NumberFormat: (000) 000-0000.

Emergency Contact 1

Emergency Contact 1 - Name

Emergency Contact 1

Emergency Contact 1 number.Format: (000) 000-0000.

Emergency Contact 2

Emergency Contact 2- Name

Emergency Contact 2- Phone

Please enter a valid phone number.Format: (000) 000-0000.

Insurance Information: Please provide the Insurance company, policy number, group number

Payment Arrangements - The cost of camp is $300 per camper. A $50 non-refundable deposit is required by July 15th, 2025. Please note: If your camper leaves early or is sent home due to behaviors, camp tuition will not be refunded.

T-Shirt Size

Your child will receive the size that you order

Camp Jabez observes Acts 2:38 Oneness Water Baptism, Does your camper have permission to be Baptized?

Yes / No

Is your camper restricted from having photos published (Foster Care)

Yes/No

Activities Consent: Do you consent for your camper to participate in off-ground activities such as sky rope course, rock climbing wall, zip lining, etc. These activities will be conducted under the direction of trained professionals, and safety gear will be required.

Yes/No

Water Activities: Do you consent for your camper to participate in water activities such as swimming, river tubing, etc?

Yes/No

Camper Agreement: Camper, do you agree to abide by all rules and directions given by Camp Jabez Staff?

Yes/No

Parent Acknowledgement: Please type your name as a signature if you understand and agree that if your camper fails to meet behavioral expectations, you will be expected to come get them as they will be dismissed from camper early and refunds will not be issued.

Type Name as a signature

Dress Code Acknowledgement: Parent and Camper BOTH please type your names as an acknowledgement that Camp Jabez has and will always continue to maintain an appropriate dress code standard: SHORTS: Shorts will need to be an appropriate length extending past the camper's fingertips with arms stretched down to the sides. Bottoms may not have writing on the back of them. SHIRTS: Shirts must be worn at all times, must cover the entire belly. No spaghetti straps will be permitted. Camp Jabez reserves the right to request campers to change when their outfit is not deemed to match our dress code.

Both Parent and Camper- Please Sign

Medication, Allergies, and Medical Issues: Please list all medications, allergies, and medical issues that we should be aware of. NOTE: If you are prescribed an Inhaler or EpiPen, campers WILL NOT be admitted without those.

Medical Information