2026 QSRR Camp (BOYS) Registration
2026 Queens Section Royal Rangers Camp Registration & Medical Release Form Boys eligible for camp must be ages 9-17.Boys eligible for camp must have graduated from the 3rd grade, and not be older than 17, regardless of high school graduation status
REGISTRATION INFORMATION
Name (First/Last)
*
Date of Birth (mm/dd/yyyy)
*
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Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
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Colorado
Connecticut
Delaware
District of Columbia
Florida
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Hawaii
Idaho
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Indiana
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Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
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Mississippi
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Montana
Nebraska
Nevada
New Hampshire
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New Mexico
New York
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Ohio
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Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Outpost
*
Age Group
*
Please Select
Discovery (Grades 3-5)
Adventure (Grades 6-8)
Expedition (Grades 9-age 17)
*Discovery (grades 3-5), Adventure (grades 6-8), Expedition (grades 9-age 17) Age group should correspond to the grade that your boy graduated from in June 2026
EMERGENCY INFORMATION
Primary Emergency Contact Name (First/Last)
*
Primary Emergency Contact Relationship
*
Primary Emergency Contact Preferred Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Secondary Emergency Contact Name (First/Last)
*
Secondary Emergency Contact Relationship
*
Secondary Emergency Contact Preferred Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
MEDICAL INFORMATION
Any known allergies, illness, injuries, or disabilities
*
Current Medications
*
Date of last Tetanus Booster (mm/dd/yyyy)
*
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Month
-
Day
Year
Date
Physician Name
*
Physician Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
INSURANCE INFORMATION
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 administeredto my child, in the event of accident, injury, sickness, etc., under thedirection of the person(s) listed, until such time as I may be contacted.I also assume theresponsibility for the payment of any such treatment. This release is effectivefor 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 thatmay occur.
Name of Parent/Guardian (Authorization & Consent)
*
Signature of Parent/Guardian (Authorization & Consent)
*
Signature Date (mm/dd/yyyy) (Authorization & Consent)
*
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Month
-
Day
Year
Date
PHOTO RELEASE FORM
I [ENTER BELOW] , parent/guardian of [ENTER BELOW] , grant permission to Queens Section Royal Rangers (QSRR) to use photographs and/or videos of my son taken at the QSRR Camp July 31 – August 2, 2026, in publications, news releases, online, and in other communications related to the mission of QSRR, Royal Rangers, and the local church.
Parent/Guardian name (Photo Release)
*
Name of Child (Photo Release – “parent/guardian of”)
*
Parent/Guardian signature (Photo Release)
*
Phone Number (Photo Release)
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address (Photo Release)
*
example@example.com
Signature Date (mm/dd/yyyy) (Photo Release)
*
-
Month
-
Day
Year
Date
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Registration Fee
*
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QSRR Camp Registration Fee
$55.00
$
55.00
Quantity
1
Item subtotal:
$0.00
$
0.00
Payment Methods
Credit Card
Apple Pay
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Google Pay
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