Camper Registration Form
Fill out the form below to register your child(ren) for Camp Jireh! To save your progress hit the save button!
Parent/Guardian Information
Full Name
*
First Name
Last Name
Are you the Father, Mother, or Legal Guardian?
*
Please Select
Father
Mother
Legal Guardian
Your Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Your Email
*
example@example.com
Your Physical Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is the above address the same as your mailing address
*
Yes
No
Your Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Camper's other parent/legal guardian
*
First Name
Last Name
Are they the Father, Mother, or Legal Guardian?
*
Please Select
Father
Mother
Legal Guardian
Their Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Their Email
*
example@example.com
Their Physical Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is the above address the same as their mailing address
*
Yes
No
Their Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
In the event of an emergency where we are unable to reach you or the camper's other parent/legal guardian, who is a good alternate emergency contact?
*
Please state their full legal name.
What is their relationship to your child?
*
What is their Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
What is the name of your child's insurance carrier?
*
What is the subscribers name?
*
What is the policy number(s)?
*
Back
Next
Save
Pick Up Permission
Please indicate any and all persons (including yourself) who are authorized to pick up your child(ren).
*
Who is the Primary Contact?
*
In the event that we need to confirm pick up permission, this person will be contacted.
What is the Primary Contact's Phone Number?
*
Please enter a valid phone number.
Format: (000) 000-0000.
Back
Next
Save
Camper Information
Camper's Name
*
First Name
Last Name
At what address does your child currently reside?
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
What week(s) would they like to come?
*
Teen Extreme 01 (ages 11 to 13) - July 13-16, 2026
Teen Extreme 02 (ages 11 to 13) - July 20-23, 2026
Adventure Week 01 (ages 5 to 10) - July 27-30, 2026
Adventure Week 02 (ages 5 to 10) - August 3-6, 2026
Ignite Camp (ages 9-12) - August 10-13, 2026
Birth Date
*
-
Month
-
Day
Year
Date Picker Icon
What is the Camper's age during camp?
*
Gender
*
Please Select
Male
Female
What grade did this camper just finish?
*
Does this camper have any food, medical, or environmental allergies?
*
Yes
No
Please list the allergies and type of reaction here:
*
Please check the following medical conditions:
*
Asthma/Breathing Difficulties
Diabetes
Hypertension (high blood pressure)
Heart Disease (CHF, CAD, MI)
Thyroid Disease
Kidney Disease
Ear/Sinus Issues
Psychiatric/Psychological Issues
Fainting Spells
Bed Wetting
Sleep Disorders (sleep apnea)/Sleep Walking
GI Problems (abdominal, digestive)
Surgery
Serious Injury
Seizures
Allergies to Insects
Autism Spectrum
Learning Disorders
None
Other
If you checked any of the previous health issues or other, please specify the health issue and share any information that the camp nurse should know:
*
Do they have any medications (including vitamins) that they take? Please list them here:
*
Will they be bringing any medications that they need to self administer? Please specify below:
*
Immunization Information
*
Please Select
My child does have an immunization record
Religious Exemption
If you have an up to date immunization record for your child, you can email it to: campjireh@cefofmaine.org or you can mail it to P.O. Box 132, Carmel, ME 04419
Legal Permission
Note: On electronic forms a typed signature has the same effect as a written signature.
- LEGAL ADULT ONLY - By typing your name into the space below you are affirming the following statement: "To the best of my knowledge, this health history is correct, and the person herein described has permission to engage in all camp activities. I hereby give permission for the camp nurse to administer prescribed medications, including non-prescription medications for mild illness, and to assess and administer treatment for my child as named above. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the camp director to secure and administer treatment, including hospitalization, and to order injections, anesthesia, or surgery for my child as named above."
*
First Name
Last Name
- LEGAL ADULT ONLY - Child Evangelism Fellowship may, from time to time, document the activities of the ministry with photos or videos. Please read the following statement and select and option below: "I hereby assign and grant to Child Evangelism Fellowship Inc., its subsidiaries and successors, and assign the unqualified right to the ownership and use of all photographs or video of me or my minor child, without reservation or limitation, including use of photographs or video of me or my minor child for, but not limited to, advertising, educational, and promotional purposes."
*
I give permission
I do not give permission
-LEGAL ADULT ONLY- You indicated that you have given permission for us to use your child's image. By typing your name into the space below, you are confirming your permission.
*
First Name
Last Name
Need to register a second Camper?
*
Please Select
Yes
No
Note: If you are registering multiple children and only one of them has a scholarship, you will need to register the child with the scholarship separately.
Is the Parent/Legal Guardian and emergency contact information the same for this Camper?
*
Please Select
Yes
No
Are the Pick Up Permissions the same for this Camper?
*
Please Select
Yes
No
Back
Next
Save
Second Camper Registration Form
Parent/Guardian Information
Full Name
*
First Name
Last Name
Are you the Father, Mother, or Legal Guardian?
*
Please Select
Father
Mother
Legal Guardian
Your Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Your Email
*
example@example.com
Your Physical Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is the above address the same as your mailing address
*
Yes
No
Your Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Camper's other parent/legal guardian
*
First Name
Last Name
Are they the Father, Mother, or Legal Guardian?
*
Please Select
Father
Mother
Legal Guardian
Their Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Their Email
*
example@example.com
Their Physical Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is the above address the same as their mailing address
*
Yes
No
Their Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
In the event of an emergency where we are unable to reach you or the camper's other parent/legal guardian, who is a good alternate emergency contact?
*
Please state their full legal name.
What is their relationship to your child?
*
What is their Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
What is the name of your child's insurance carrier?
*
What is the subscribers name?
*
What is the policy number(s)?
*
Back
Next
Save
Second Camper Pick Up Permission
Please indicate any and all persons (including yourself) who are authorized to pick up your child(ren).
*
Who is the Primary Contact?
*
In the event that we need to confirm pick up permission, this person will be contacted.
What is the Primary Contact's Phone Number?
*
Please enter a valid phone number.
Format: (000) 000-0000.
Back
Next
Save
Second Camper Information
Camper's Name
*
First Name
Last Name
At what address does your child currently reside?
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
What week(s) would they like to come?
*
Teen Extreme 01 (ages 11 to 13) - July 13-16, 2026
Teen Extreme 02 (ages 11 to 13) - July 20-23, 2026
Adventure Week 01 (ages 5 to 10) - July 27-30, 2026
Adventure Week 02 (ages 5 to 10) - August 3-6, 2026
Ignite Camp (ages 9-12) - August 10-13, 2026
Birth Date
*
-
Month
-
Day
Year
Date Picker Icon
What is the Camper's age during camp?
*
Gender
*
Please Select
Male
Female
What grade did this camper just finish?
*
Does this camper have any food, medical, or environmental allergies?
*
Yes
No
Please list the allergies and type of reaction here:
*
Please check the following medical conditions:
*
Asthma/Breathing Difficulties
Diabetes
Hypertension (high blood pressure)
Heart Disease (CHF, CAD, MI)
Thyroid Disease
Kidney Disease
Ear/Sinus Issues
Psychiatric/Psychological Issues
Fainting Spells
Bed Wetting
Sleep Disorders (sleep apnea)/Sleep Walking
GI Problems (abdominal, digestive)
Surgery
Serious Injury
Seizures
Allergies to Insects
Autism Spectrum
Learning Disorders
None
Other
If you checked any of the previous health issues or other, please specify the health issue and share any information that the camp nurse should know:
*
Do they have any medications (including vitamins) that they take? Please list them here:
*
Will they be bringing any medications that they need to self administer? Please specify below:
*
Immunization Information
*
Please Select
My child does have an immunization record
Religious Exemption
If you have an up to date immunization record for your child, you can email it to: campjireh@cefofmaine.org or you can mail it to P.O. Box 132, Carmel, ME 04419
Legal Permission
Note: On electronic forms a typed signature has the same effect as a written signature.
- LEGAL ADULT ONLY - By typing your name into the space below you are affirming the following statement: "To the best of my knowledge, this health history is correct, and the person herein described has permission to engage in all camp activities. I hereby give permission for the camp nurse to administer prescribed medications, including non-prescription medications for mild illness, and to assess and administer treatment for my child as named above. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the camp director to secure and administer treatment, including hospitalization, and to order injections, anesthesia, or surgery for my child as named above."
*
First Name
Last Name
- LEGAL ADULT ONLY - Child Evangelism Fellowship may, from time to time, document the activities of the ministry with photos or videos. Please read the following statement and select and option below: "I hereby assign and grant to Child Evangelism Fellowship Inc., its subsidiaries and successors, and assign the unqualified right to the ownership and use of all photographs or video of me or my minor child, without reservation or limitation, including use of photographs or video of me or my minor child for, but not limited to, advertising, educational, and promotional purposes."
*
I give permission
I do not give permission
-LEGAL ADULT ONLY- You indicated that you have given permission for us to use your child's image. By typing your name into the space below, you are confirming your permission.
*
First Name
Last Name
Need to register a third Camper?
*
Please Select
Yes
No
Note: If you are registering multiple children and only one of them has a scholarship, you will need to register the child with the scholarship separately.
Is the Parent/Legal Guardian and emergency contact information the same for this Camper?
*
Please Select
Yes
No
Are the Pick Up Permissions the same for this Camper?
*
Please Select
Yes
No
Back
Next
Save
Third Camper Registration Form
Parent/Guardian Information
Full Name
*
First Name
Last Name
Are you the Father, Mother, or Legal Guardian?
*
Please Select
Father
Mother
Legal Guardian
Your Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Your Email
*
example@example.com
Your Physical Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is the above address the same as your mailing address
*
Yes
No
Your Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Camper's other parent/legal guardian
*
First Name
Last Name
Are they the Father, Mother, or Legal Guardian?
*
Please Select
Father
Mother
Legal Guardian
Their Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Their Email
*
example@example.com
Their Physical Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is the above address the same as their mailing address
*
Yes
No
Their Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
In the event of an emergency where we are unable to reach you or the camper's other parent/legal guardian, who is a good alternate emergency contact?
*
Please state their full legal name.
What is their relationship to your child?
*
What is their Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
What is the name of your child's insurance carrier?
*
What is the subscribers name?
*
What is the policy number(s)?
*
Back
Next
Save
Third Camper Pick Up Permission
Please indicate any and all persons (including yourself) who are authorized to pick up your child(ren).
*
Who is the Primary Contact?
*
In the event that we need to confirm pick up permission, this person will be contacted.
What is the Primary Contact's Phone Number?
*
Please enter a valid phone number.
Format: (000) 000-0000.
Back
Next
Save
Third Camper Information
Camper's Name
*
First Name
Last Name
At what address does your child currently reside?
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
What week(s) would they like to come?
*
Teen Extreme 01 (ages 11 to 13) - July 13-16, 2026
Teen Extreme 02 (ages 11 to 13) - July 20-23, 2026
Adventure Week 01 (ages 5 to 10) - July 27-30, 2026
Adventure Week 02 (ages 5 to 10) - August 3-6, 2026
Ignite Camp (ages 9-12) - August 10-13, 2026
Birth Date
*
-
Month
-
Day
Year
Date Picker Icon
What is the Camper's age during camp?
*
Gender
*
Please Select
Male
Female
What grade did this camper just finish?
*
Does this camper have any food, medical, or environmental allergies?
*
Yes
No
Please list the allergies and type of reaction here:
*
Please check the following medical conditions:
*
Asthma/Breathing Difficulties
Diabetes
Hypertension (high blood pressure)
Heart Disease (CHF, CAD, MI)
Thyroid Disease
Kidney Disease
Ear/Sinus Issues
Psychiatric/Psychological Issues
Fainting Spells
Bed Wetting
Sleep Disorders (sleep apnea)/Sleep Walking
GI Problems (abdominal, digestive)
Surgery
Serious Injury
Seizures
Allergies to Insects
Autism Spectrum
Learning Disorders
None
Other
If you checked any of the previous health issues or other, please specify the health issue and share any information that the camp nurse should know:
*
Do they have any medications (including vitamins) that they take? Please list them here:
*
Will they be bringing any medications that they need to self administer? Please specify below:
*
Immunization Information
*
Please Select
My child does have an immunization record
Religious Exemption
If you have an up to date immunization record for your child, you can email it to: campjireh@cefofmaine.org or you can mail it to P.O. Box 132, Carmel, ME 04419
Legal Permission
Note: On electronic forms a typed signature has the same effect as a written signature.
- LEGAL ADULT ONLY - By typing your name into the space below you are affirming the following statement: "To the best of my knowledge, this health history is correct, and the person herein described has permission to engage in all camp activities. I hereby give permission for the camp nurse to administer prescribed medications, including non-prescription medications for mild illness, and to assess and administer treatment for my child as named above. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the camp director to secure and administer treatment, including hospitalization, and to order injections, anesthesia, or surgery for my child as named above."
*
First Name
Last Name
- LEGAL ADULT ONLY - Child Evangelism Fellowship may, from time to time, document the activities of the ministry with photos or videos. Please read the following statement and select and option below: "I hereby assign and grant to Child Evangelism Fellowship Inc., its subsidiaries and successors, and assign the unqualified right to the ownership and use of all photographs or video of me or my minor child, without reservation or limitation, including use of photographs or video of me or my minor child for, but not limited to, advertising, educational, and promotional purposes."
*
I give permission
I do not give permission
-LEGAL ADULT ONLY- You indicated that you have given permission for us to use your child's image. By typing your name into the space below, you are confirming your permission.
*
First Name
Last Name
Need to register a fourth Camper?
*
Please Select
Yes
No
Note: If you are registering multiple children and only one of them has a scholarship, you will need to register the child with the scholarship separately.
Is the Parent/Legal Guardian and emergency contact information the same for this Camper?
*
Please Select
Yes
No
Are the Pick Up Permissions the same for this Camper?
*
Please Select
Yes
No
Back
Next
Save
Fourth Camper Registration Form
Parent/Guardian Information
Full Name
*
First Name
Last Name
Are you the Father, Mother, or Legal Guardian?
*
Please Select
Father
Mother
Legal Guardian
Your Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Your Email
*
example@example.com
Your Physical Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is the above address the same as your mailing address
*
Yes
No
Your Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Camper's other parent/legal guardian
*
First Name
Last Name
Are they the Father, Mother, or Legal Guardian?
*
Please Select
Father
Mother
Legal Guardian
Their Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Their Email
*
example@example.com
Their Physical Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is the above address the same as their mailing address
*
Yes
No
Their Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
In the event of an emergency where we are unable to reach you or the camper's other parent/legal guardian, who is a good alternate emergency contact?
*
Please state their full legal name.
What is their relationship to your child?
*
What is their Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
What is the name of your child's insurance carrier?
*
What is the subscribers name?
*
What is the policy number(s)?
*
Back
Next
Save
Fourth Camper Pick Up Permission
Please indicate any and all persons (including yourself) who are authorized to pick up your child(ren).
*
Who is the Primary Contact?
*
In the event that we need to confirm pick up permission, this person will be contacted.
What is the Primary Contact's Phone Number?
*
Please enter a valid phone number.
Format: (000) 000-0000.
Back
Next
Save
Fourth Camper Information
Camper's Name
*
First Name
Last Name
At what address does your child currently reside?
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
What week(s) would they like to come?
*
Teen Extreme 01 (ages 11 to 13) - July 13-16, 2026
Teen Extreme 02 (ages 11 to 13) - July 20-23, 2026
Adventure Week 01 (ages 5 to 10) - July 27-30, 2026
Adventure Week 02 (ages 5 to 10) - August 3-6, 2026
Ignite Camp (ages 9-12) - August 10-13, 2026
Birth Date
*
-
Month
-
Day
Year
Date Picker Icon
What is the Camper's age during camp?
*
Gender
*
Please Select
Male
Female
What grade did this camper just finish?
*
Does this camper have any food, medical, or environmental allergies?
*
Yes
No
Please list the allergies and type of reaction here:
*
Please check the following medical conditions:
*
Asthma/Breathing Difficulties
Diabetes
Hypertension (high blood pressure)
Heart Disease (CHF, CAD, MI)
Thyroid Disease
Kidney Disease
Ear/Sinus Issues
Psychiatric/Psychological Issues
Fainting Spells
Bed Wetting
Sleep Disorders (sleep apnea)/Sleep Walking
GI Problems (abdominal, digestive)
Surgery
Serious Injury
Seizures
Allergies to Insects
Autism Spectrum
Learning Disorders
None
Other
If you checked any of the previous health issues or other, please specify the health issue and share any information that the camp nurse should know:
*
Do they have any medications (including vitamins) that they take? Please list them here:
*
Will they be bringing any medications that they need to self administer? Please specify below:
*
Immunization Information
*
Please Select
My child does have an immunization record
Religious Exemption
If you have an up to date immunization record for your child, you can email it to: campjireh@cefofmaine.org or you can mail it to P.O. Box 132, Carmel, ME 04419
Legal Permission
Note: On electronic forms a typed signature has the same effect as a written signature.
- LEGAL ADULT ONLY - By typing your name into the space below you are affirming the following statement: "To the best of my knowledge, this health history is correct, and the person herein described has permission to engage in all camp activities. I hereby give permission for the camp nurse to administer prescribed medications, including non-prescription medications for mild illness, and to assess and administer treatment for my child as named above. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the camp director to secure and administer treatment, including hospitalization, and to order injections, anesthesia, or surgery for my child as named above."
*
First Name
Last Name
- LEGAL ADULT ONLY - Child Evangelism Fellowship may, from time to time, document the activities of the ministry with photos or videos. Please read the following statement and select and option below: "I hereby assign and grant to Child Evangelism Fellowship Inc., its subsidiaries and successors, and assign the unqualified right to the ownership and use of all photographs or video of me or my minor child, without reservation or limitation, including use of photographs or video of me or my minor child for, but not limited to, advertising, educational, and promotional purposes."
*
I give permission
I do not give permission
-LEGAL ADULT ONLY- You indicated that you have given permission for us to use your child's image. By typing your name into the space below, you are confirming your permission.
*
First Name
Last Name
Need to register a fifth Camper?
*
Please Select
Yes
No
Note: If you are registering multiple children and only one of them has a scholarship, you will need to register the child with the scholarship separately.
Is the Parent/Legal Guardian and emergency contact information the same for this Camper?
*
Please Select
Yes
No
Are the Pick Up Permissions the same for this Camper?
*
Please Select
Yes
No
Back
Next
Save
Fifth Camper Registration Form
Parent/Guardian Information
Full Name
*
First Name
Last Name
Are you the Father, Mother, or Legal Guardian?
*
Please Select
Father
Mother
Legal Guardian
Your Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Your Email
*
example@example.com
Your Physical Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is the above address the same as your mailing address
*
Yes
No
Your Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Camper's other parent/legal guardian
*
First Name
Last Name
Are they the Father, Mother, or Legal Guardian?
*
Please Select
Father
Mother
Legal Guardian
Their Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Their Email
*
example@example.com
Their Physical Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is the above address the same as their mailing address
*
Yes
No
Their Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
In the event of an emergency where we are unable to reach you or the camper's other parent/legal guardian, who is a good alternate emergency contact?
*
Please state their full legal name.
What is their relationship to your child?
*
What is their Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
What is the name of your child's insurance carrier?
*
What is the subscribers name?
*
What is the policy number(s)?
*
Back
Next
Save
Fifth Camper Pick Up Permission
Please indicate any and all persons (including yourself) who are authorized to pick up your child(ren).
*
Who is the Primary Contact?
*
In the event that we need to confirm pick up permission, this person will be contacted.
What is the Primary Contact's Phone Number?
*
Please enter a valid phone number.
Format: (000) 000-0000.
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Fifth Camper Information
Camper's Name
*
First Name
Last Name
At what address does your child currently reside?
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
What week(s) would they like to come?
*
Teen Extreme 01 (ages 11 to 13) - July 13-16, 2026
Teen Extreme 02 (ages 11 to 13) - July 20-23, 2026
Adventure Week 01 (ages 5 to 10) - July 27-30, 2026
Adventure Week 02 (ages 5 to 10) - August 3-6, 2026
Ignite Camp (ages 9-12) - August 10-13, 2026
Birth Date
*
-
Month
-
Day
Year
Date Picker Icon
What is the Camper's age during camp?
*
Gender
*
Please Select
Male
Female
What grade did this camper just finish?
*
Does this camper have any food, medical, or environmental allergies?
*
Yes
No
Please list the allergies and type of reaction here:
*
Please check the following medical conditions:
*
Asthma/Breathing Difficulties
Diabetes
Hypertension (high blood pressure)
Heart Disease (CHF, CAD, MI)
Thyroid Disease
Kidney Disease
Ear/Sinus Issues
Psychiatric/Psychological Issues
Fainting Spells
Bed Wetting
Sleep Disorders (sleep apnea)/Sleep Walking
GI Problems (abdominal, digestive)
Surgery
Serious Injury
Seizures
Allergies to Insects
Autism Spectrum
Learning Disorders
None
Other
If you checked any of the previous health issues or other, please specify the health issue and share any information that the camp nurse should know:
*
Do they have any medications (including vitamins) that they take? Please list them here:
*
Will they be bringing any medications that they need to self administer? Please specify below:
*
Immunization Information
*
Please Select
My child does have an immunization record
Religious Exemption
If you have an up to date immunization record for your child, you can email it to: campjireh@cefofmaine.org or you can mail it to P.O. Box 132, Carmel, ME 04419
Legal Permission
Note: On electronic forms a typed signature has the same effect as a written signature.
- LEGAL ADULT ONLY - By typing your name into the space below you are affirming the following statement: "To the best of my knowledge, this health history is correct, and the person herein described has permission to engage in all camp activities. I hereby give permission for the camp nurse to administer prescribed medications, including non-prescription medications for mild illness, and to assess and administer treatment for my child as named above. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the camp director to secure and administer treatment, including hospitalization, and to order injections, anesthesia, or surgery for my child as named above."
*
First Name
Last Name
- LEGAL ADULT ONLY - Child Evangelism Fellowship may, from time to time, document the activities of the ministry with photos or videos. Please read the following statement and select and option below: "I hereby assign and grant to Child Evangelism Fellowship Inc., its subsidiaries and successors, and assign the unqualified right to the ownership and use of all photographs or video of me or my minor child, without reservation or limitation, including use of photographs or video of me or my minor child for, but not limited to, advertising, educational, and promotional purposes."
*
I give permission
I do not give permission
-LEGAL ADULT ONLY- You indicated that you have given permission for us to use your child's image. By typing your name into the space below, you are confirming your permission.
*
First Name
Last Name
Need to register a sixth Camper?
*
Please Select
Yes
No
Note: If you are registering multiple children and only one of them has a scholarship, you will need to register the child with the scholarship separately.
Is the Parent/Legal Guardian and emergency contact information the same for this Camper?
*
Please Select
Yes
No
Are the Pick Up Permissions the same for this Camper?
*
Please Select
Yes
No
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Sixth Camper Registration Form
Parent/Guardian Information
Full Name
*
First Name
Last Name
Are you the Father, Mother, or Legal Guardian?
*
Please Select
Father
Mother
Legal Guardian
Your Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Your Email
*
example@example.com
Your Physical Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is the above address the same as your mailing address
*
Yes
No
Your Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Camper's other parent/legal guardian
*
First Name
Last Name
Are they the Father, Mother, or Legal Guardian?
*
Please Select
Father
Mother
Legal Guardian
Their Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Their Email
*
example@example.com
Their Physical Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is the above address the same as their mailing address
*
Yes
No
Their Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
In the event of an emergency where we are unable to reach you or the camper's other parent/legal guardian, who is a good alternate emergency contact?
*
Please state their full legal name.
What is their relationship to your child?
*
What is their Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
What is the name of your child's insurance carrier?
*
What is the subscribers name?
*
What is the policy number(s)?
*
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Sixth Camper Pick Up Permission
Please indicate any and all persons (including yourself) who are authorized to pick up your child(ren).
*
Who is the Primary Contact?
*
In the event that we need to confirm pick up permission, this person will be contacted.
What is the Primary Contact's Phone Number?
*
Please enter a valid phone number.
Format: (000) 000-0000.
Back
Next
Save
Sixth Camper Information
Camper's Name
*
First Name
Last Name
At what address does your child currently reside?
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
What week(s) would they like to come?
*
Teen Extreme 01 (ages 11 to 13) - July 13-16, 2026
Teen Extreme 02 (ages 11 to 13) - July 20-23, 2026
Adventure Week 01 (ages 5 to 10) - July 27-30, 2026
Adventure Week 02 (ages 5 to 10) - August 3-6, 2026
Ignite Camp (ages 9-12) - August 10-13, 2026
Birth Date
*
-
Month
-
Day
Year
Date Picker Icon
What is the Camper's age during camp?
*
Gender
*
Please Select
Male
Female
What grade did this camper just finish?
*
Does this camper have any food, medical, or environmental allergies?
*
Yes
No
Please list the allergies and type of reaction here:
*
Please check the following medical conditions:
*
Asthma/Breathing Difficulties
Diabetes
Hypertension (high blood pressure)
Heart Disease (CHF, CAD, MI)
Thyroid Disease
Kidney Disease
Ear/Sinus Issues
Psychiatric/Psychological Issues
Fainting Spells
Bed Wetting
Sleep Disorders (sleep apnea)/Sleep Walking
GI Problems (abdominal, digestive)
Surgery
Serious Injury
Seizures
Allergies to Insects
Autism Spectrum
Learning Disorders
None
Other
If you checked any of the previous health issues or other, please specify the health issue and share any information that the camp nurse should know:
*
Do they have any medications (including vitamins) that they take? Please list them here:
*
Will they be bringing any medications that they need to self administer? Please specify below:
*
Immunization Information
*
Please Select
My child does have an immunization record
Religious Exemption
If you have an up to date immunization record for your child, you can email it to: campjireh@cefofmaine.org or you can mail it to P.O. Box 132, Carmel, ME 04419
Legal Permission
Note: On electronic forms a typed signature has the same effect as a written signature.
- LEGAL ADULT ONLY - By typing your name into the space below you are affirming the following statement: "To the best of my knowledge, this health history is correct, and the person herein described has permission to engage in all camp activities. I hereby give permission for the camp nurse to administer prescribed medications, including non-prescription medications for mild illness, and to assess and administer treatment for my child as named above. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the camp director to secure and administer treatment, including hospitalization, and to order injections, anesthesia, or surgery for my child as named above."
*
First Name
Last Name
- LEGAL ADULT ONLY - Child Evangelism Fellowship may, from time to time, document the activities of the ministry with photos or videos. Please read the following statement and select and option below: "I hereby assign and grant to Child Evangelism Fellowship Inc., its subsidiaries and successors, and assign the unqualified right to the ownership and use of all photographs or video of me or my minor child, without reservation or limitation, including use of photographs or video of me or my minor child for, but not limited to, advertising, educational, and promotional purposes."
*
I give permission
I do not give permission
-LEGAL ADULT ONLY- You indicated that you have given permission for us to use your child's image. By typing your name into the space below, you are confirming your permission.
*
First Name
Last Name
Back
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Did a camper (or campers) you registered receive a scholarship for Camp Jireh 2026?
*
Please Select
Yes
No
Name of camper(s) who received scholarship:
*
Please give first and last name.
Please give the scholarship information below:
*
Which week(s) are you using this scholarship for?
*
Teen Extreme 1
Teen Extreme 2
Adventure Week 1
Adventure Week 2
Ignite Camp
Save
Submit
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