Explorers 2026 Camp Registration

Explorers Camp Registration 2026
Camper's Information
Name

First NameLast Name
MaleFemale
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birth Date*

MonthDayYear
Grade completed*
Church Name*
Shirt Size*
Email Confirmation
Parents Email *
example@example.com
Parent/Legal Guardian and Emergency Contact Information
Parent/Legal Guardian*
Name
Relationship*
Cell Phone*
Format: (000) 000-0000.
Emergency Contact information
Emergency contact Name (If person above is not available)*
Name
Relationship*
Cell Phone*
Format: (000) 000-0000.
Health Information
YesNo
Date of last tetanus shot
Any activity the camper should be restricted from?
Any physical, mental or other condition that would require special attention or medication while at camp?
What Medication does the camper take, how much and when. Please put medication in a plastic baggie with camper's first and last name. No expired medication will be accepted.
List any allergies (ex: bees, peanuts, dairy)
YesNo
Physician/Clinic Name
Physician Phone
Please enter a valid phone number.Format: (000) 000-0000.
Insurance card

Cancelof
You agree that you are the parent or legal guardian of the above named camper, and are over the age of 18. In case of medical emergency or general medical care, I give consent for medical teatment for the aboved named camper by authorized personnel. I understand that the above named camper will only be released to the names listed above, an update may be done at registration. I certify that my child has my permission to attend camp and participate in all activites.
I acknowledge and agree
Food Allergies
YesNo
If yes, please specify your food allergies
Please list any other dietary issues we should know about?
Photo & Media Acknowledgement
I understand that Plain Baptist Camp, may take photographs and/or video recordings during camp activities that may include my child. I acknowledge that these images may be used by the camp for promotional and informational purposes, including social media, printed materials, and digital communications.

I understand that images will be used respectfully and without identifying personal information.

I acknowledge and agree to the above.
I acknowledge and agree
Notice About Camp Location & Safety
Parts of our camp property including some lodges are located within a designated 100 year floodplain.

This does not mean that the camp floods regularly. It simply means that during unusually heavy rainfall, certain low-lying areas have the potential to hold water.

We actively monitor weather conditions, have written emergency procedures, and our staff are trained to move campers to higher ground and safe buildings if needed.

Safety is our highest priority, and we continually review and update our plans with this in mind.
Electronic Signature Consent
By typing my name below, I understand and agree that this constitutes my electronic signature and is legally binding to the same extent as a handwritten signature.
Parent/Guardian Full Name (Electronic Signature):*
Date*

MonthDayYear
Date
Minor Liability & Assumption of Risk Acknowledgement
Liability Release & Assumption of Risk (Minors)

I am the parent or legal guardian of the minor listed on this registration. I understand that participation in camp activities involves inherent risks, including but not limited to physical activity, outdoor environments, weather conditions, recreational equipment, and interaction with other participants.

I knowingly and voluntarily consent to my child’s participation in activities at Plain Baptist Camp and assume responsibility for all risks of injury, illness, or property damage that may arise from participation, except in cases of gross negligence.

On behalf of my child, I release, waive, and hold harmless Plains Baptist Camp, its staff, volunteers, directors, and agents from liability for injury, loss, or damage arising from participation in camp activities.

I understand this acknowledgment is intended to be as broad and inclusive as permitted by law.

By submitting this form, I certify that I am the parent or legal guardian and acknowledge that I have read, understand, and agree to the above.
I acknowledge and agree
Should be Empty:

Explorers Camp Registration 2026

Camper's Information

Email Confirmation

Parent/Legal Guardian and Emergency Contact Information

Emergency Contact information

Health Information

Food Allergies

Photo & Media Acknowledgement

Notice About Camp Location & Safety

Minor Liability & Assumption of Risk Acknowledgement