Please get your application in by June 17th. T-shirts cannot be ordered after this date.
Name
First Name
Last Name
Age at camp
Male
Female
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Would you like to purchase a t-shirt for $15? *Cannot be ordered after 6/17/26*
Yes
No
T-shirt Size
Please Select
Youth XS
Youth small
Youth medium
Youth large
Youth XL
Adult small
Adult medium
Adult large
Adult XL
Adult 2X
Adult 3X
Adult 4X
Other-please check with Britney for other sizes
Health Insurance Company
Contract/ policy numbers
Health Conditions
*
Please Select
No Known Health Concerns
Allergies (Including food- Please Explain Below)
Asthma
Diabetes
Heart Condition
High Blood Pressure
Seizures
Other
Please explain any allergies or additional health conditions.
Date of last tetanus shot if known.
Is camper under 18 years old AND WILL need medication while at camp? *medication must be checked in with camp nurse.
*
yes
no
EMERGENCY Contact Name
*
First Name
Last Name
Emergency contact phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
*
In case of emergency, I understand that every effort will be made to contact my emergency contact. In the event they cannot be reached, I give permission to the camp staff to seek medical treatment on my or my child's behalf.
I give permission to The Church of God and it's representatives to take photos of me and/or my children. I agree that these photos may be used on any social media or publications.
*
yes
no
Signature (Parent/Guardian if camper is under 18 years old)
*
If signing for a minor please type your name below
Continue
Continue
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