Clone of 2025 Registration for Intro Camp & Camp Agape

2026 Registration for Camp Agape Full Week & Intro Camp Weekend

Please complete and submit this registration form for Intro Camp Weekend or Full Week Camp Agape. This form includes our camper covenant and a health history section. The form will take some time to complete.
Intro Camp Weekend: June 5-7 (Completed 1st - 3rd grade)

or

Camp Agape Full Week: June 7-13 (Completed 3rd - 12th grade)
Each camper you register will require a separate registration form.

Once you complete this form, you will still need to download the health physical form from the website for your child's doctor to complete. The health physical form is required at the time of arrival at camp or your child will not be able to attend camp.
Select the camp/age group and gender you are signing up for. If there are no spots available that means that age group is full. You can email campagapefrc@gmail.com to be put on the waiting list.*
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Intro Camp Weekend Completed 1st - 3rd grade
$225.00



Explorer GirlsCompleted 3rd - 5th Grade (Full Week)
$600.00



Explorer BoysCompleted 3rd - 5th Grade (Full Week)
$600.00



Pathfinder GirlsCompleted 6th - 8th Grade
$625.00



Pathfinder BoysCompleted 6th - 8th Grade
$625.00



Adventure GirlsCompleted 9th - 12th Grade
$650.00



Adventure BoysCompleted 9th - 12th Graders
$650.00



Senior Interns (Hybrid Leadership Camp)Completed 11th or 12th Grade
$325.00



Total

$0.00
CAMPER INFORMATION
Camper's Name*

First NameLast Name
Birth Date*

MonthDayYear
Gender*
Age of Camper at the Time of Camp Agape*
School grade level camper completed in May 2026*
Roommate Request (We will try to accommodate requests when possible.)
Camper's T-Shirt Size *
Please check your selection after you click on it to make sure it selected the correct size. We will not have extra shirts.
Camper's Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

PARENT/GUARDIAN INFORMATION
Parent/Guardian's Name*

First NameLast Name
Parent/Guardian's Mobile Number*
Parent/Guardian's Email*
example@example.com
Relationship to Camper*
Address of Parent/Guardian if different from Camper

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
2nd Guardian or Emergency Contact Information

If the primary guardian(s) will be hard to reach during camp, please put the information of an emergency contact who we can reach in case you are not available during an emergency.
Name of 2nd Guardian or Emergency Contact*

First NameLast Name
2nd Guardian or Emergency Contact's Relationship to Camper*
2nd Guardian or Emergency Contact's Phone Number*
Please enter a valid phone number.
2nd Guardian or Emergency Contact's Email*
example@example.com
Additional Emergency Contact (Optional)
Name of Additional Emergency Contact

First NameLast Name
Additional Emergency Contact's Relationship to Camper
Phone Number of Additional Emergency Contact
Please enter a valid phone number.

CAMP AGAPE POLICIES
Read each item and check the box to show that you understand the policy.*

COVID Protocol - Yes, I understand and agree that my camper may be required to wear a mask when visiting the local assisted living facility on our service project day. I understand and agree that my camper may be sent home early if they develop COVID symptoms and test positive for COVID. We strongly recommend testing your child for COVID before arriving at camp so that your child does not get sent home without a refund if they test positive at camp. Partial refunds are available prior to the start of camp.Health Forms - Yes, I understand there is a separate health physical form page that must be completed and signed by a healthcare provider and turned in to the camp medical team upon arrival for check-in. To download the doctor required page, visit our Camp Agape web page. CAMPAGAPEPSL.COMPhoto Permission - Yes, I understand this form gives permission for Camp Agape staff to take pictures and videos during camp. I understand these pictures may be added to the Camp Agape photo gallery, as well as, used in future camp publicity items.Permission for Staff Awareness - Yes, I understand this form gives permission for any information on this form to be shared with my child's camp counselor and Camp Agape administrative staff.Field Trip Permission - Yes, I understand this form gives my child permission to go on offsite field trips with Camp Agape. (The entire camp travels on school buses to the Louisiana War Veterans Home in Jackson, LA. The campers sing for the veterans, bring them items made at camp, and visit with them after. During the week, the Adventure Camp goes to one off-site activity like tubing or hiking. Camp counselors drive the Adventure campers to and from the off-site location.)

PAYMENT INFORMATION
How Will You Be Paying the Camp Fee?*

I will pay the entire fee myself using PayPalI will pay the entire fee myself by mailing a check.I will pay part of the fee using PayPal, and my church will pay the remaining balance.I will pay part of the fee by mailing a check, and my church will pay the remaining balance.My church will pay for the entire fee.
What Church are you connected with? (N/A if you are not part of a church community.)*
How much of the fee will you be paying? This information helps us if we need to invoice a church.

	1st Medication	2nd Medication	3rd Medication	4th Medication
Name of Medication
Reason for taking this medication
Time of day medication is taken
Amount/Dosage given each time
Additional information we may need

2026 Registration for Camp Agape Full Week & Intro Camp Weekend

Each camper you register will require a separate registration form.

CAMPER INFORMATION

Please check your selection after you click on it to make sure it selected the correct size. We will not have extra shirts.

PARENT/GUARDIAN INFORMATION

2nd Guardian or Emergency Contact Information

Additional Emergency Contact (Optional)

CAMPER COVENANT

As a child of God and in an effort to be with others in a safe way and have fun as a Christian community, I will covenant to:

Camper Acknowledgement

CAMP AGAPE POLICIES

PAYMENT INFORMATION

CAMPER HEALTH HISTORY

GENERAL HEALTH

ALLERGIES

DIET & NUTRITION

PHYSICAL RESTRICTIONS

IMMUNIZATION HISTORY

MEDICATIONS

MEDICATION INFORMATION

MEDICAL CARE WHILE AT CAMP

MENTAL, EMOTIONAL & SOCIAL HEALTH

ADDITIONAL INFORMATION

MEDICAL INSURANCE

PARENT/GUARDIAN AUTHORIZATION FOR HEALTH CARE:

Digital Signature of Legal Guardian