Clone of Camp Crossroads 2026 - Summer Camp Detailed Registration Form

Camp Crossroads June 6 2026

Day Camp for Youth
Camp Crossroads Camp Registration

All Submissions Due by June 15, 2026
Who is Sending Church? (Type None if No Home Church)*
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:*
Enter 0 for Kindergarten to going into the 6th Grade
Camper's Birth Date:*

MonthDayYear
Camper's Age:*
4yrs - 12yrs old
Camper T-Shirt Size*
Youth & Adult XS/S/M/L/XL
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:*
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 Wayfinder Elmwood Jr. Camp.
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 6 2026

Camp Crossroads Camp Registration

Camper Information:

Leader Information:

Parent/Guardian Information:

Emergency Contact Information:

Medical Information:

Camp Consent