2026 Bible Camp Application
June 7th - 12th, Grades 4-10
2025 Church of God Bible Camp
Camper Application
Camper Name:
*
First Name
Last Name
Birth Date:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Present Age:
*
Grade Next Fall:
*
Gender:
*
Male
Female
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Camper Email:
example@example.com
Camper Phone Number:
Please enter a valid phone number.
Format: (000) 000-0000.
Home Church:
T-shirt Size:
*
Youth M
Youth L
Adult S
Adult M
Adult L
Adult XL
Other
There may be boating and tubing available during free time each day. Please indicate if you give permission for you child to participate:
*
Yes, my child may participate in boating activities
No, my child may not participate in boating activities
Camper's Health Information
Physician's Name:
Physician's Phone Number:
Please enter a valid phone number.
Format: (000) 000-0000.
Insurance Carrier:
*
Phone Number:
Please enter a valid phone number.
Format: (000) 000-0000.
Name of Insured:
*
First Name
Last Name
Member Number:
*
List any health issues and/or activity or diet restrictions:
List any drug allergies / allergic reactions:
List regular medications and detailed instructions for use:
All medications except inhalers and bee sting medications must be checked in at registration and dispensed by the camp nurse.
Tetanus Booster within 5 years?
Yes
Parent/Guardian Name:
*
First Name
Last Name
Parent/Guardian Phone Number:
*
Please enter a valid phone number.
Format: (000) 000-0000.
Secondary Emergency Contact:
*
First Name
Last Name
Secondary Contact Phone Number:
*
Please enter a valid phone number.
Format: (000) 000-0000.
Secondary Contact Relationship to Camper:
Parent/Guardian Signature
Type your name here in leu of signature
Date:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Camper Signature
Type your name here in leu of signature
Date:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: