Camper Registration Form

Camper Registration Form

(Entering Grades 2-10)
Camper Information
Name*

First NameLast Name
Desired Name Tag
T-Shirt Size*
Gender*
Pronouns
Date of Birth*

MonthDayYear
Grade for 2026-2027 School Year*
Camper (or a member of Camper's family) has been to Camp Firebird before
If family member, please specify

Church Affiliation
Are you or your family affiliated with an Episcopal Church in the Diocese of Missouri? *
Which one?

Parent/Guardian Information
Parent/Guardian's Name*

First NameLast Name
Contact Phone Number*
Email Address*
Home Address*

Street Address

Street Address Line 2

CityState

Zip Code

Emergency Contact Information
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Emergency Contact Email*
Relationship to Camper(s)*
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Emergency Contact Email*
Relationship to Camper(s)*

Releases
The health and safety of our campers and staff are of the utmost importance to us. Camp MoVal's nurse has the special responsibility of providing medical care and attention. The nurse treats all campers, dispenses all required medications and is available to deal with illnesses and emergencies during the entirety of the session. All campers are required to visit the nurse’s table at check-in.

Signing this form confirms that you have entered in accurate medical information about your camper, that you understand our policies listed here and on our website, and that you agree to be bound by them.
Medical Release*

I hereby give permission to the medical personnel selected by the camp director to provide routine health care; to administer medications; to order X-rays, routine tests, treatment and to release any records necessary for insurance purposes. In the event I cannot be available in an emergency, I hereby give permission to the physician selected by the camp director to secure and administer treatment, including hospitalization. I understand that I, the parent/guardian, am responsible for any fees incurred related to necessary off-site medical cares.I authorize Camp Firebird to provide or authorize any transportation or emergency medical treatment that may be necessary for my child(ren), if any should appear necessary. I understand the risks inherent in such transportation and treatment and intend the above waiver to apply equally to such transportation and treatment.All the information I have provided in this form is accurate to the best of my knowledge.
Photo, Media, and Social Media Release*

I release Camp Firebird to record—via still photo, video, audio, or other methods—likenesses of my child(ren) for use in promotional materials to be used by Camp Firebird and the Episcopal Diocese of Missouri. I understand these recordings may be edited at the discretion of Camp Firebird and the Diocese of Missouri and may be published in promotional videos, brochures, websites, newspapers, and other media. I hereby waive all rights to compensation for the use of these recordings.Please do not use the likeness of my child(ren) in promotional materials
Signature*

Clear

Cost and Scholarships
Tiered Pricing is a personal pricing system that many summer camps across the country are now using. Camp Firebird does careful cost analysis and works hard to keep fee increases to a minimum, while at the same time the costs to run a high-quality summer camp continue to increase. Camp Firebird knows and understands that families have different abilities to pay for an Episcopal camping experience, and that you know your family's financial situation better than we do. This allows you to choose the rate that best fits your financial situation. The pricing option you choose remains confidential and in no way influences the experience your camper receives.

You take an active role in supporting the true cost of your child's camp experience, which enables us to direct the contributions from our generous donors to support other areas of need in the camping ministry, including program and staffing. Registration will be available on our Camp Firebird webpage beginning January 7. Registration and payments must be submitted no later than May 31, 2026. If you have questions, please contact co-directors, The Rev. Erin Pickersgill (Bear) or Katrina Moore (Compass).

Scholarships No camper will be excluded because of the cost of camp. We have a scholarship fund available just for Campers! If you would like to request a full or partial scholarship, please choose "scholsarship" in the dropdown box below. We will send you a simple form to complete.
Please choose a pricing option. *
Will a church be covering all or part of your camper's registration fee?*

YesNoI don't know
If yes, which church? *
Please specify the name and city of the church.
If you know how much they are contributing, please enter it here.

Payment Details
- A minimum $50 deposit is required to secure your camper's spot at Camp Firebird.
- Any remaining balance will be due by June 30.
- If a church is covering all or part of your camper's registration, we will send them an invoice for the amount you indicated.
- If you indicated that you are requesting a scholarship, no payment is required at this time. We will be in touch to work out the details.
- The Diocese of Missouri has made the commitment that NO CAMPER WILL BE TURNED AWAY BECAUSE OF THE COST OF CAMP. In 2025 46% of our campers received full or partial scholarships. If you would like to support the efforts of the Diocese of Missouri to ensure that every student has the opportunity to attend camp, you may add a tax-deductible contribution to the scholarship fund below.
Scholarship Contribution
Amount Due
Amount you would like to pay today:

prevnext( X )
USD
Remaining balance
Should be Empty:

Camper Registration Form

Camper Information

Church Affiliation

Parent/Guardian Information

Emergency Contact Information

Health Information

Medication

Medical Insurance

Immunization History

General Health History

Mental, Emotional, and Social Health

Health-Care Providers

Releases

Cost and Scholarships

Payment Details