Camp Monroe Community Camp at Cornerstone Presbyterian Church Registration and Waiver

Camp Monroe Community Camp at Cornerstone Presbyterian Church Registration and Waiver

Community Camp will be at Cornerstone Presbyterian Church, 2220 High House Rd, Cary, NC 27519, July 27-31, 2026 from 9 am-4 pm led by staff from Camp Monroe in Laurel Hill, NC. This camp is for kids age 6-14 (will be divided into groups based on age). Please bring a lunch, but snacks are provided. Cost is $65 for the week. You can pay with cash, card or check when you arrive on Monday! If you need a scholarship reach out to Cornerstone at meg@cornerstonecary.org.
Camper Information
First Name
Last Name
Date of Birth

MonthDayYear
Date
Gender
T-Shirt Size
Which days will you attend Community Camp at Cornerstone? (If anything changes, just let us know)
Family Information
Parent/Guardian Name (Primary)
Address (Primary)

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Cell Phone (Primary)
Please enter a valid phone number.Format: (000) 000-0000.
Email (Primary)
example@example.com
Secondary Contact/Emergency Contact Information
Parent/Guardian Name (Secondary/Emergency)
Address (Secondary/Emergency)

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Cell Phone (Secondary/Emergency)
Please enter a valid phone number.Format: (000) 000-0000.
Email (Secondary/Emergency)
example@example.com
Insurance Information
Insurance Company
Insurance Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Insurance Reference Number
Name on Insurance
Medical Information
Does the camper need medicine while at Community Camp?
Medication 1 - Time (AM/LUNCH/PM)
Medication 1 - Name
Medication 1 - Dose
Medication 2 - Time (AM/LUNCH/PM)
Medication 2 - Name
Medication 2 - Dose
Does the camper have allergies we need to know about?
Allergy Details (If Yes, What?)
Conditions we need to be aware of
Dietary Restrictions
General Program Release

Note: Many of the items listed are for Camp Monroe's on-site camps and don't apply to Community Camp, but please acknowledge each item.
I * , (Parent/Guardian) wish for my child,* (child's full name) to participate in Monroe Camp and Retreat Center, Inc.’s summer camping program through its camp, in Laurel Hill, N.C.
I AM HERBY ADVISED by the Staff of Monroe Camp and Retreat Center, Inc. of thefollowing in regards to the summer camping program: (check each statement and sign below):
I have been fully advised of the nature of the summer camping program I and my heirs hereby fully release and hold harmless, Monroe Camp and Retreat Center, Inc. and its camp, its employees and representatives, from any and all claims, losses, liabilities, demands, actions and causes of action that might mature or accrue subsequent to the date of this release on the account of, Monroe Camp and Retreat Center during the summer. In addition, I am aware the likeness of my child can be used as required by Monroe Camp and Retreat Center.
I have carefully read and understand this release, and have had the opportunity to ask questions about this release and all such questions have been fully answered. With full knowledge of its contents I hereby sign this release voluntarily on behalf of my child who is a minor.
Participant’s Name (bottom of Program Release)
Parent or Guardian Signature (Program Release)
Date (Program Release)

MonthDayYear
Date
Should be Empty:

Camp Monroe Community Camp at Cornerstone Presbyterian Church Registration and Waiver

Camper Information

Family Information

Secondary Contact/Emergency Contact Information

Insurance Information

Medical Information

General Program Release