Kids Camp Camper Registration 2024

Emergency/Medical Information
Name of Parent/Guardian*

First NameLast Name
Phone Number*

Area CodePhone Number
E-mail*
Emergency Contact if Parent/Guardian can't be reached*
Name
Emergency Contact if Parent/Guardian can't be reached*
Phone Number
Required Medications

Camper must provide nurse with meds upon arrival at camp.

There will be a nurse on site to dispense medications and provide first aid. All meds (prescription and non-perscription) MUST be in the original container and labeled with patient's full name and directions. Put all medication in clear plastic baggie with child's name on it.
Allergies or restrictions. If none put NA*
Please list Medication(s) - dosage and frequency. If none put NA*
Physical Limitations
Last Tetanus Shot*

MonthDayYear
Does camper carry an epi-pen?*

YesNo
Do you have health insurance?*

YesNo
Insurance name and policy number and phone number. If none put NA*
I authorize the staff of NW District Wesleyan Kids Camp 2024 to call for emergency ambulance if needed.*

Yes, it is ok
In the event that I cannot be reached in an emergency during the dates specified on this form, I hereby give my permission to the physician or dentist selected by the church leadership to hospitalize, to secure proper treatment and / or injection, anesthesia, or surgery for my son or daughter as deemed necessary. Every activity is carefully planned and adequately supervised by mature adults. However, even with the best of planning and precaution, unforeseen events can occur. By signing this form, the parent or guardian agrees to assume and accept all risks inherent in church related social activities. They also agree not to hold this church or its employees or volunteers liable for damages, losses, or injuries to the person or property undersigned. The parents or guardians understand that they are signing for the minor listed on this form and the signature is for both a medical and liability release. (Signed by Parent/Legal Guardian)*

First NameLast NameDate

Dietary Needs
If camper has severe food allergies or intolerances, they may need to bring supplemental food. The kitchen can accommodate pasta and bread substitutions and some vegetarian options. This information helps the kitchen prepare appropriate quantities.
Dietary Needs*

VegetarianCeliacGluten intolerantNONEOther
Food Allergies Please list all food allergies, severity and treatment if exposed.

Camp Rules
Camp Rules

Rules exist to allow EVERYBODY to have the most fun possible by keeping us all safe. We want you to have the time of your life at camp, so that is why we have a few rules we ask everybody to follow.

1. Girls are not allowed in boys' cabins and boys are not allowed in girls' cabins.

2. RESPECT gets RESPECT! Talk nice to your counselors, staff, and other campers, and respect their stuff too.

3. Never be alone - always have a buddy everywhere you go, and ensure your counselor knows where you are at all times.

4. NO ELECTRONICS!!!

5. EVERYBODY comes to EVERYTHING.

6. And most importantly - SMILE and HAVE FUN!!!
I have read the camp rules to my child and understand that they must be followed. If not, it will be the parents' responsibility to pick up the child, with no refund given.*

Yes
------------Extra Information-------------
Is there anything specific about your child we should know that will help us give him or her a great time at camp?
Should be Empty:

Kids Camp Camper Registration - $250 June 17-21, 2024

Emergency/Medical Information

Dietary Needs

Camp Rules