HHBC Camper Registration and Consent Form

HOOSIER HILLS BAPTIST CAMP
REGISTRATION & CONSENT FORM

This is not a payment form. Please visit our website or contact your pastor for payment info.

Camper Name*

First NameLast Name

CHURCH Name**

(Full name; no abbreviations, please)

CHURCH City*

CHURCH State*

*If you are not sending your camper with a church group, put your info instead.

Jr Week 1 (June 8th-12th, 2026)Jr Week 2 (July 6th-10th, 2026)Teen Week 1 (June 15th-19th, 2026)Teen Week 2 (July 13th-17th, 2026)

Church/Sponsor Email*

A confirmation of form submission will be sent to this email.

Camper Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Age*

Birthday*

Date

Grade in Fall*

MaleFemale

______________________________________

IMMMUNIZATIONS, ALLERGIES, MEDICATIONS, OTHER

Yes (please specify in the section below)No

YesNo

Date of Tetanus Shot

List any allergies & reactions; physical, health, or behavioral limitations; current medications and dosages.

All medication is to be given to the Camp Nurse at check-in in original, labeled containers with dosage instructions.

______________________________________

PARENT/LEGAL GUARDIAN & EMERGENCY CONTACT INFO

Parent/Legal Guardian Name*

First NameLast Name

Parent/Legal Guardian Phone #*

Format: (000) 000-0000.

Parent/Legal Guardian Email*

Confirmation of form submission will be sent to this email.

YesNo

Emergency Contact Name*

First NameLast Name

Emergency Contact Phone #*

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

Secondary Emergency Contact Name (optional)

First NameLast Name

Secondary Emergency Contact Phone # (optional)

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

______________________________________

INSURANCE INFO

Note: Campers are under an accident insurance policy while on the campus. Coverage is an Excess Plan. All claims will first be submitted to the parent/legal guardian's insurance carrier.

Insurance Policy Holder's Name*

First NameLast Name

Policy #

Insurance Company Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

______________________________________

STATEMENT OF LIABILITY

I Understand the Following:

Campers are expected to cooperate in activities, and abide by camp policies of conduct and attire. The camp reserves the right to dismiss campers who fail to follow these guidelines. I give permission for my child to participate in all on-site activities. Photos or videos of my child can be used for promotional purposes without remuneration. I understand that Hoosier Hills Baptist Camp is a Christian camp where Christian principles will be taught. I understand the camp will provide medical care to my child for injuries or illnesses, that camp reserves the right to bill me for excessive medical supplies, and that all off-site medical expenses will be directed through the parent's health insurance policy. I understand that the camp coverage is an Excess Plan. In case of a medical emergency, I understand that every reasonable effort will be made to contact me. If cannot be reached, I give permission to secure reasonable medical treatment. I understand if my child has a communicable disease, sickness, or lice and/or nits, the camp reserves the right to take appropriate precautions, including dismissal.

By entering my name below, I show that I agree to the terms of the liability statement. *

Parent/Guardian First NameParent/Guardian Last Name

Date*

Date

(If you do not receive a confirmation email after clicking "submit," please contact secretary@hoosierhillsbaptistcamp.org to let us know).