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  • CAMP REFUGE 2026 REGISTRATION

  • CAMPERS INFORMATION

  • Date of Birth:*
     - -
  • Gender:
  • Format: (000) 000-0000.

  • EMERGENCY CONTACT INFORMATION

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • MEDICAL INFORMATION

  • Does your child suffer from a health condition that threatens their life?*
  • Is your child in need of medication at camp?*
  • Do you have any other medical issues or allergies we should know about your child?*

  • PHOTO AND VIDEO PERMISSION

  • Please check one:*
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  • Permission and Liability Release

  • I, the parent or legal guardian of the minor listed on this registration form, give permission for my child to participate in all camp activities sponsored by the church. I understand that participation may involve physical activity and travel, and I acknowledge that there are inherent risks associated with these activities.

  • In the event of an accident, illness, or medical emergency, I authorize the camp staff and/or church leadership to obtain medical treatment for my child, including transportation to a medical facility and treatment by a licensed physician or medical professional, if I cannot be reached in a timely manner. I also grant permission for the church and its representatives to provide my child's health insurance information, as listed on this registration form, to medical providers and facilities as needed for the purpose of securing treatment and processing insurance claims.
  • I understand that every reasonable effort will be made to contact me or the emergency contacts listed. I further agree that the church, its staff, volunteers, and representatives shall not be held liable for any injury, illness, loss, or damage to personal property that may occur during participation in camp activities.
  • I certify that the information provided on this form is accurate and complete, including medical, allergy, and insurance information. I understand that failure to disclose relevant medical or behavioral information may place my child at risk and release the church from responsibility related to undisclosed conditions.
  • By signing below, I acknowledge that I have read and understand this release, and I agree to its terms.
  • Date:*
     - -

  • INSURANCE INFORMATION

  • Format: (000) 000-0000.
  • Insurance Policy:*
  • Date of Birth:*
     - -
  • Should be Empty: