Camper Registration Form

Camper Registration Form

June 28th-July 3rd, 2026 at Laurel Lake Baptist Camp - $150 per participant
Church Name
Church Name
Pastor's Name
Pastor's Name
Camper's Full Name

First NameLast Name
Camper Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Gender
Email Address
example@example.com
Primary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Phone Number (Emergency Contact)
Please enter a valid phone number.Format: (000) 000-0000.
Date of Birth

MonthDayYear
Date
Age
T-Shirt Size
Camper Agreement
I/We in consideration of my/our child’s participation in Camp Adullam 2026 at the laurel Lake Baptist Camp in Corbin, KY, do for myself/ourselves assume all risks of personal injury or property damage sustained by my/our child arising out of the child’s participation in Camp Adullam 2026 activities conducted on and off the campus, and release, acquit and forever discharge Camp Adullam and Laurel Lake Baptist Camp from any and all claims, damages, actions, or causes of action , for personal injury or property damage sustained by me/us or my/our child, in any way arising out of or connected with my/our child’s participation in Camp Adullam 2026 activities conducted on and off the Laurel Lake Baptist Camp. I/we hold Camp Adullam/Laurel Lake Baptist Camp harmless from any and all liability resulting from any claim, demand, action or cause of action made by me/us or my/our child in connection with my/our child’s participation in Camp Adullam 2026 activities conducted on and off the Laurel Lake Baptist Camp. Photos, audio and video captured by our team during Camp Adullam 2026 are the exclusive property of Camp Adullam and its designers and may be used in future resources, recordings, DVD, print and web media. Camp attendance is an expression of the individual release of rights for such use. By my signing below, I acknowledge that I have read, completely understand, and hereby agree to obey the rules and regulation of participation in all Camp Adullam 2026 activities. I also agree to follow the leadership of the Camp Adullam Staff and counselors and Laurel Lake Baptist Camp staff.
Camper Signature
Parent/Guardian Signature
Date Signed

MonthDayYear
Date
BY ACKNOWLEDGING AND SIGNING ABOVE, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
All medical information will be completed on the next page.

You will be REQUIRED to submit a copy of the camper's insurance card.

Medical Registration Form
Emergency Contact Information
Emergency Contact First and Last Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Optional Second Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Does the camper have any known allergies?
List of Allergies
Does the camper have any activity restrictions?
List of Restrictions
Does the camper have a chronic physical condition?
List of Chronic Conditions
List any chronic conditions here.
Does the camper require any special dietary needs (such as gluten-free, diabetic dietary needs, etc.)?
List of Dietary Needs
Does the camper have any required present medication?
List of Medications
In case of needed medical attention, permission is given to the camp and its designee to seek appropriate medical care for the camper. For this purpose, the following information is given below
Family Physician
Family Physician Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Insurance Company
Group Number
Identification Number (ID #)
I, Parent/Guardian Name , hereby state that the above-named Camp Adullam participant is in good physician condition and has no contagious or infectious disease or symptoms of the same as of this date.
Parent/Guardian Signature
Date Signed

MonthDayYear
Date
By acknowledging and signing above, I am delivering an electronic signature that will have the same effect as an original manual paper signature. The electronic signature will be equally as binding as an original manual paper signature.
A copy of the insurance card for the camper is required to keep on file in case of medical emergency. Please upload a copy of the front and back of insurance card below. Note: if you are taking a picture of the insurance card, please make sure the picture is clear and the information on the card is easily visible.
Insurance Card Upload

Cancelof
Should be Empty:

Camper Registration Form

Medical Registration Form

Emergency Contact Information