Clone of Camp Crossroads 2025 - Summer Camp Detailed Registration Form

Camp Crossroads June 15-19 2026

with Evangelist Stephen Curry
Camp Crossroads Camp Registration

All Submissions Due by June 15, 2026
Elmwood Baptist ChurchCommunity Baptist ChurchCyrus Creek Baptist ChurchMount Hope Baptist ChurchMud River Baptist Church
CamperLeader
Camper Information:
Camper's Name:*

First NameLast Name
Camper's Preferred Name:
(Any name other than their legal name)
MaleFemale
Grade Camper is Going Into:*
6th - 13th Grade
Camper's Birth Date:*

MonthDayYear
Camper's Age:*
12yrs - 20yrs old
Camper T-Shirt Size*
XS/S/M/L/XL/XXL/XXXL
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Leader Information:
Leader's Name:*

First NameLast Name
Leader's Preferred Name:
(Any name other than their legal name)
MaleFemale
Leader T-Shirt Size*
XS/S/M/L/XL/XXL/XXXL
Leader's Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information:
Parent/Guardian Full Name:*

First NameLast Name
Parent/Guardian Relationship:*
(Mother, Father, Grandparent, or Guardian)
Parent/Guardian E-mail:*
example@example.com
Parent/Guardian Primary Number:*

Area CodePhone Number
YesNo
HomeWorkN/A
Parent/Guardian Alt. Number:*

Area CodePhone Number
YesNo
Parent/Guardian Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Information:
YesNo
Emergency Contact's Name:*

First NameLast Name
Emergency Contact's Relationship*
Emergency Contact's Primary Phone:*

Area CodePhone Number
YesNoN/A
HomeWorkN/A
Emergency Contact's Alt. Phone Number:*

Area CodePhone Number
Medical Information:
YesNo
If Yes, Please List Allergy, Severity, Reaction, and Treatment*
YesNo
YesNo
Inhaler Instructions.*
YesNo
If Yes, Please Describe:*
YesNo
DiabetesHeart ConditionsLung ConditionsMusculoskeletal ConditionsOther Condition Not Listed
Please Describe Any Impact or Treatments Needed:*
YesNo
If Yes, Please List for Administration by Camp Nurse:*
Yes - Please Click Links Below and Follow the Online Payment ProcessNo - Paying by cash or checkNo - Payment by Sending Church (Not Elmwood)
Click Here to Pay Elmwood Leader Fee

Leaders Pay - $50.00
Click Here to Pay Elmwood Camper Fee

Campers Pay - $65.00
Camp Consent
Informed Consent and Acknowledgement I hereby give my approval for my child’s participation in any and all activities prepared by the churches represented of Camp Crossroads.
Medical Release and Authorization As Parent and/or Guardian of the named camper, I hereby authorize Camp Crossroads Nurse to provide first aid and basic medical services as described above. This release is authorized and executed with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of the named minor child, in my absence.
Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Signature
Printed Name*
Name of Authorized Signature Above
Should be Empty:

Camp Crossroads June 15-19 2026

Camp Crossroads Camp Registration

Camper Information:

Leader Information:

Parent/Guardian Information:

Emergency Contact Information:

Medical Information:

Camp Consent