Clone of 2025 KS FWB Church Camp Registration Form (Kid Camp)

KS FWB Church Camp - Kid Camper's Form

June 30 - July 03
Registration Details:

Registration Deadline for Campers is June 14, 2026 at 11:59 p.m.. Campers will not be allowed to come if not signed up by this date.

Camp will be held at Camp Crossway in Pawnee, OK

Kid Camp: June 30 - July 03 for 1-4 grades (school grade 2025-2026)

Payment:

The cost for camp is $150. Speak to your church's camp director on if you are to pay during registration (at the end of this form) or they will be paying.

If you have any questions, please contact your church camp coordinator first or contact Charlotte Brooks at Wellington FWB Church at 620.326.5521.

Camper Information
Camper Name*

First NameLast Name
Sex*

MaleFemale
School Grade (2025-2026)*
Date of Birth*

MonthDayYear
Age:*
Insurance Company Name*
If no insurance put "N/A"
Insurance Member ID*
If no card put "0"
Upload Insurance Card

Browse Files
Please take a picture of insurance card and upload it here Cancelof
Allergies or Other Medical Conditions:*
If none, type "N/A"
Church Attending With*

PARENT/GUARDIAN INFORMATION
Parent/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Postal CodeCountry
Cell Phone Number*
##########Format: 0000000000.
E-mail*
Emergency Contact (other than the parent above)

In the case that we are unable to reach you in an emergency, please provide the name and number of someone we can contact (other than the parent above).
Emergency Contact Name*

First NameLast Name
Phone Number*

Area CodePhone Number

Release of Liability
I hereby agree to be responsible for the conduct and actions of my child and to release the Kansas State Association of Free Will Baptist and the Kansas State Association of Free Will Baptist Christian Education Board from any claims and demands that may occur during participation of "Church Camp." Furthermore, I agree to release the Kansas State Association of Free Will Baptist and the Kansas State Association of Free Will Baptist Christian Education Board and its workers and I will hold them harmless from any liability which may arise from accidents or incidents involving my child and myself, to the extent allowed by the law. I authorize attending adults or physician to administer emergency medical care to my child should the need arise.
Signature*
Date*

MonthDayYear
Date

Dispensing Medications Form

This form is derived from Kansas Department of Health and Environment. It has been formatted to be fillable. If you want to look at the original document and print and use the original, please go to the link provided. If you want to use the original, please still fill out the document below. https://www.kdhe.ks.gov/DocumentCenter/View/1038/CCL-027-Long-Term-Medication-Authorization-PDF
Authorization for Dispensing Medications to Children and Youth - Long-term Medications (Prescription and Non-Prescription)
Prescription medications must be in their original containers labeled with the child's/youth's first and last name; the name of the licensed physician, physician assistant (PA), or advanced practice registered nurse (APRN) who ordered the medication; the date the prescription was filled; the expiration date of the medication; and specific, legible instructions for administration and storage of the medication. Administer the medication only to the child designated on the prescription label in accordance with the instructions on the label. Non-prescription medications can be given with written permission and direction from the parent or legal guardian. Administer nonprescription medication from the original container labeled with the first and last name of the child/youth and according to the instructions on the label.
Name of Child/Youth

First NameLast Name
Date of Birth

MonthDayYear
Date
Name of Medication
Type of Medication

PrescriptionNon-Prescription
Reason for Medication
Dose
Time to be given
Start Date

MonthDayYear
Date
Stop Date

MonthDayYear
Date
Name of Medication
Type of Medication

PrescriptionNon-Prescription
Reason for Medication
Dose
Time to be given
Start Date

MonthDayYear
Date
Stop Date

MonthDayYear
Date
Name of Licensed Physician prescribing the medication
**Stop date not to exceed one year from the start date. A new authorization is to be completed any time the medication, dosage, times to be given, or instructions from the parent or health care provider change from the information included on this form. Additional copies of this form may be attached to this page if more space is needed to record the administration of the medication for up to one year if there are no changes in instructions. Above information must be completed on each page but the parent's signature is required only once per year.**
Parent's Signature
Date

MonthDayYear
Date
If you are needing to add more medication, please fill out the medicine release form found on our website. Click the link and it will direct you to the form.

Suggested Items to Bring:

Send Items for Each Individual Camper
1. Bible, pencil, and notepad.
2. Personal hygiene items (toothpaste, shower supplies, etc.).
3. Turn in medication at camp to nurse.
4. Clothing for 4 days (See dress code below).
5. Bedding for twin mattress (sleeping bag, twin sheets, blanket, pillow, etc.).
6. Towels/Wash Cloth.
7. Swimsuit (See dress code below).
8. Lifejacket or other swim assisted device if needed for your child.
9. Money for offerings (Optional).
10. Money for concessions (Optional - recommended $20).
11. Tennis shoes (Required).
Rules for Kansas FWB Church Camp
1. Campers should not leave the grounds without notifying the Director.
2. No visitors are allowed at camp.
3. Boys should not enter girl's sleeping area. Girls should not enter boy's sleeping area.
4. Physical contact is not allowed between any campers specifically in a violent or intimate nature.
5. Tobacco, e-cigs, drugs, and alcohol are prohibited at camp.
6. Weapons and fireworks are prohibited at camp.
7. Cell phones and other electronic devices are prohibited at camp.
8. Campers and counselors must attend all activities and services.
9. Campers should carry out all instructions given by camp workers.
Any person who breaks these rules or encourages someone else to do so may be dismissed from camp on the first offense at the discretion of the Director.

Dress Code:

Knee-length shorts are allowed all day. Shorts are not allowed for evening service. Leggings are not permitted. Short sleeves shoudl reach the shoulder bone with no revealing midriff or chest. Closed-toed tennis shoes are very important for safety and comfort. During swimming, if girls are wearing a two-piece swimsuit they need a t-shirt on. Campers should arrive at check-in dressed in camp attire. Remember to pack 4 daytime outfits, 4 evening outfits, as well as sleeping and miscellaneous clothes as needed.
Please only click to pay if you have talked to your church's camp director.
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Registration$150.00
Cost for campers attending church camp.

Total $0.00
Should be Empty:

KS FWB Church Camp - Kid Camper's Form

Camper Information

PARENT/GUARDIAN INFORMATION

Emergency Contact (other than the parent above)

Release of Liability

Dispensing Medications Form

Authorization for Dispensing Medications to Children and Youth - Long-term Medications (Prescription and Non-Prescription)