2025 QSRR Camp Registration(BOYS)

2025 Queens Section Royal Rangers
Camp Registration & Medical Release Form
BOYS

Boys eligible for camp must be ages 9-17. Boys eligible for camp must have graduated from the 3rd grade, and not be older than
17, regardless of high school graduation status
Registration Information
Name (First/Last)*
Date of Birth (mm/dd/yyyy)*

MonthDayYear
Date
Address*

Address

Street Address Line 2

CityState

Zip Code
Outpost*
Age Group*
* Discovery (grades 3-5), Adventure (grades 6-8), Expedition (grades 9-age 17) Age group should correspond to the grade that your boy graduated from in June 2025
Emergency Information
Primary Emergency Contact Name (First/Last)*
Relationship*
Preferred Phone Number*
Secondary Emergency Contact Name (First/Last)*
Relationship*
Preferred Phone Number*
Medical Information
Any known allergies illness injuries or disabilities*
Current Medications*
Date of last Tetanus Booster (mm/dd/yyyy)*

MonthDayYear
Date
Physician Name*
Physician Phone Number*
Insurance Information
Insurance Company*
Insurance Phone Number*
Policy Holders Name*
Policy Number*
Authorization & Consent
I, hereby grant permission, for all medical attention to be administered to my child, in the event of accident, injury, sickness, etc., under the direction of the person(s) listed, until such time as I may be contacted. I also assume the responsibility for the payment of any such treatment. This release is effective for the Queens Sectional Royal Rangers Sectional Camp August 1-3, 2025. I will not hold the Queens Section Royal Rangers Spanish Eastern District, Koinonia Camp or the participants' local church liable for any accident that may occur.
Name of (Parent/Guardian)*
Signature of (Parent/Guardian)*

Clear
Signature Date (mm/dd/yyyy)*

MonthDayYear
Date
Photo Release Form
Name of Parent/Guardian*
Name of Child*
I [NAME OF PARENT/GUARDIAN], parent/guardian of [NAME OF CHILD], grant permission to Queens Section Royal Rangers (QSRR) to use photographs and/or videos of my son taken at the QSRR Camp, August 1-3, 2025, in publications, news releases, online, and in other communications related to the mission of QSRR, Royal Rangers, and the local church.
Parent/Guardian name*
Parent/Guardian signature*

Clear
Phone Number*
Email Address*
example@example.com
Signature Date (mm/dd/yyyy)*

MonthDayYear
Date

Payment*

2025 Queens Section Royal Rangers Camp Registration Fee

$55 Quantity

Enter coupon

Payment Methods

Credit Card

Apple Pay

Google Pay

Should be Empty:

Registration Information

Emergency Information

Medical Information

Insurance Information

Authorization & Consent

Photo Release Form

Payment Methods