Smunchkin' Camp Registration Form
Camp for those ages 3-going into 3rd grade and their parent/guardian
Please only one Smunchkin' camper per form
Smunchkin' Name
First Name
Last Name
Registering for...
Smunchkin' Camp 1 Waitlist
Smunchkin' Camp 2 Waitlist
We are flexible, put us in either Smunchkin' camp Waitlist
Parent/Guardian Name
First Name
Last Name
Parent/Guardian E-mail
*
example@example.com
Parent/Guardian Cell Number
*
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent or Guardian Addending Smunchin' Camp
Lodging Preference (We do our best)
Bunk Cabin
Room in the House
Shared Bunk House
We are happy with any situation
Cabin Request: Smunchkin's and guardians automatically are bunked together. This is if you are coming with a friend and it would appropriate for you to share space.
Camper Dietary Restrictions
Parent/Guardian Dietary Restrictions
Additional Comments
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Smunchkin' Camper Health Form
Smunchkin' Camper Name
*
First Name
Last Name
Smunchkin' Camper Date of Birth
*
-
Month
-
Day
Year
Date
Biological Sex
Please Select
Female
Male
Emergency Contact (not attending camp)
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Allergies
Food Allergies
*
Please Select
Yes
No
List Food Allergies below
Medicine Allergies
*
Please Select
Yes
No
List Allergies to Medicine Below
Known risk of Anaphylactic Allergic Reaction?
*
Please Select
Yes
No
List of known Allergies and Explanation of reactions.
General Medical Information
Things camp staff should know...
For example health history, recent medical changes, important things to be aware of...
Any activities camper should not participate in?
Parent or Guardian Health information
Parent or Guardian
First Name
Last Name
Food Allergies
*
Please Select
Yes
No
List Food Allergies below
Medicine Allergies
*
Please Select
Yes
No
List Allergies to Medicine Below
Known risk of Anaphylactic Allergic Reaction?
*
Please Select
Yes
No
List of known Allergies and Explanation of reactions.
Anything else the cam staff should be made aware of...
For example health history, recent medical changes, important things to be aware of...
Medical and Photo Release
I (We) consent to medical attention by the Baptist Youth Camp staff and should it be necessary other health care providers. By typing my name below I give permission to receive medical care as well as permission to be photographed for camp materials.
Signature
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