Camp Ephraim 2026 - Camper Form

Parent/Guardian Information

A legal parent or guardian is required to fill this form out.
Name (Parent/Guardian)*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email (Parent/Guardian)*
example@example.com
Address (Parent/Guardian)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Camper Info

Remember to fill out one form for each student.
Choose a week your camper will be attending

WEEK 1: Monday, June 29th - Friday, July 3rdWEEK 2: Monday, July 6th - Friday, July 10th
Name (Camper)

First NameLast Name
Age
Grade
Shirt Size
Desired Performance Group
Students will be allowed to change performance groups during camp or be asked to join other groups depending on the needs of our final performance.
Instrument

Electric GuitarAcoustic GuitarPianoBassOther
Years of experience
Is there anything else you would like to let us know about your child? (e.g. talents, interests, other performance group interest or experiences, any other things that will help camp be more fun and more exciting!)

Authorized Adult for Pickup (optional)

Please fill out any information for any adult. To ensure the safety of your child we will be requiring a valid ID or driver's license for any adult authorized to pick up your child. Every authorized pickup must be at least 18 years of age.
Name (Authorized Pickup)

First NameLast Name
Phone Number (Authorized Pickup)
Please enter a valid phone number.Format: (000) 000-0000.
Email (Authorized Pickup)
example@example.com
Relationship to Camper (Authorized Pickup)

Emergency Contact
Name (Emergency)*

First NameLast Name
Phone Number (Emergency)*
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Camper (Emergency)

Health Info

Please list all health concerns that would be good to know to keep your camper safe.
Allergies
Medication
Additional Information
Anything that would be helpful for us to know.

Please read and review the following terms and conditions of Camp Ephraim 2026.
CONSENT

I hereby agree and declare that I am (we are) the legal parent/guardian(s) of the registered child or camper and hereby consent to the child’s participation in the activities described above. I understand that activities of the kind described above may result in physical injury to my child but nonetheless specifically request that he or she be allowed to participate in those activities. If the above-named child requires any emergency medical treatment or procedures during the activities, I hereby consent to and authorize the above-named activity supervisor(s) to make any decision and take any action to arrange for such procedures or treatments in the discretion of the activity supervisor(s). I, the parent/guardian, hereby agree and declare that I have carefully read and understand the general provisions, understand its contents, and agree to its terms and conditions.
Parent/Guardian Signature*

Camper Form