2026 QSRR Camp Registration (ADULTS)

2026 QSRR Camp Registration (ADULTS)

Please note: This form is for adults 18 and over.Adults are male leaders, or guests who are staying on camp for the weekend.
Name (First/Last)

First NameLast Name
Date of Birth (mm/dd/yyyy)

MonthDayYear
Date
Address

Street Address

Street Address Line 2
CityStateZip Code
Email Address
example@example.com
Outpost
Leader or Guest*
*Leaders are men who work in the local outpostGuests are men who are assisting the outpost for the weekend: Pastors, van drivers, fathers, etc.Boys who graduated from high school in June are considered leaders, regardless of age.
Emergency Contact Name (First/Last)

First NameLast Name
Relationship
Preferred Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Any known allergies, illness, injuries, or disabilities
Current Medications
Date of last Tetanus Booster (mm/dd/yyyy)

MonthDayYear
Date
Physician Name
Physician Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Insurance Company
Insurance Company Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Policy Holder’s Name
Policy Number
Authorization & Consent

I, hereby grant permission, for all medical attention to be administered to my child, in the event of accident, injury, sickness, etc., under the direction of the person(s) listed, until such time as I may be contacted.I also assume the responsibility for the payment of any such treatment. This release is eﬀective for the Queens Sectional Royal Rangers Sectional Camp July 31 – August 2, 2026. I will not hold the Queens Section Royal Rangers Spanish Eastern District, Koinonia Camp or the participants' local church liable for any accident that may occur.
Name (Authorization & Consent)
My signature
Signature Date (mm/dd/yyyy)

MonthDayYear
Date

2026 QSRR Camp Registration (ADULTS)

Authorization & Consent

Registration Fee

Payment Methods

2026 QSRR Camp Registration (ADULTS)

Authorization & Consent

Registration Fee*

Payment Methods

Registration Fee