Camp Good News: Richmond

Camp Good News Registration Form 2025
Week Attending*

July 2025 Richmond Youth Camp, Aberdeen, SD
Camper's Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Grade*
Going in to grades 1-7
Gender*

MaleFemale
Parent/Guardian*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Postal Code
Email*
example@example.com
Request a Cabin Mate
Requesting a cabin mate doesn't guarantee that you will bunk with them.
Other than parents picks up a camper, other pickup instruction
If a child to leave the camp facilities they must be named by a parent or guardian before check in

Emergency Contact Information
Name*

First NameLast Name
Relationship to Camper*
Address (If different from camper)*

Street Address

Street Address Line 2

CityState

Zip Code
Best Emergency Phone Number*

Area CodePhone Number
Relationship to Camper*
Health Insurance Company*
Policy Number*
Date of Camper's Last tetanus shot or booster

MonthDayYear
Date
Special Diet Requirements
Allergies
List any medical conditions which may affect the camper's stay
All medication including non prescription, must be checked in the first day of camp to the medical staff. All medication must be in the original bottle. prescription medications will only be administered according to written prescription unless doctor's note indicates otherwise.
Medications (Both prescription and non-prescription)

In case of a medical emergency, I understand every effort will be made to contact parent/guardian of campers. In the event I cannot be reached I hereby give permission to the medical staff selected by the camp director to hospitalize, secure proper treatment, and to order injection, anesthesia, or surgery for my child. Parent/Guardian(s) are responsible for the insurance coverage while their child is attending camp. Any outside charges incurred relating to sickness or illness by your child will be billed to parent/guardian(s).

HIPPA Statement

I authorize Child Evangelism Fellowship to discuss my child's health information with camp volunteers and healthcare providers as necessary.

Designated medical staff will be present to administer medications and in case of emergencies. The camp has permission to administer Tylenol, Ibuprofen, over the counter topical medications, to my child as needed.

I consent to have my child participate in the activites of Child Evangelism Fellowship, Inc., Child Evangelism of SD, Inc., and Camp Good News and certify that I will hold CEF and Camp Good News, its directors, employees, or agents harmless from any of all liability and claims arising out of participation in or in connection with the program of Camp Good News.
Photo Release

By summiting also agree that any photographs or videos of my child taken at camp or written comments made by my child or me may be used by CEF for art, advertising, or promotion. I waive my right to inspect or approve the finished product or copy.
Authorized Parent/Guardian Signature

First NameLast Name
Date

MonthDayYear
Date
My Products
prevnext( X )
Camp Good News 2024$125.00
Camp registration

Quantity
Item subtotal:$0.00

Total $0.00
Should be Empty:

Camp Good News Registration Form 2025

Emergency Contact Information