• Middle School 2021 Camp Registration Form

    July 6-10, 2021
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  • HEALTH INFORMATION

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  • Photocopy of the front and back of the insurance card MUST be provided by uploading the file in the space below.

    Please indicate "N/A" in the required fields below if the camper has no insurance.

  • MEDICATIONS BEING TAKEN

  • Please list ALL medications taken routinely. Bring medications in the original packaging/bottle that identifies the prescribing physician (if a prescription drug), the name of the medication, the dosage, and the frequency of administration.

  • PHOTOGRAPH RELEASE

    I hereby give Crossroads permission to use photographs/video/sound of the child named in this registration form for publicity, promotion, news releases, videos, and web use of Crossroads. This might also apply to the written composition or visual art of the person if it is published. This would only be for the church use and marketing promotion.

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  • PARENT/GUARDIAN PERMISSION

    I hereby give my permission for the child named in this registration form to take part in all Crossroads activities. I hereby give my permission for the designated/approved church representative or sponsor to secure any needed medical treatment for the aboved named child. I release Crossroads Church from liability for accident or injuries on these trips or from these activities.

    I further understand and agree that, in the event that the above named child be involved in any non-Christian or dangerous behaviors/activities, I will pay his or her expenses to be sent home immediately at the discretion of the approved sponsors and/or church representatives.

    I have supplied, understood, and agree to all the information contained on this document.

  • By clicking submit you are agreeing that ALL payments are non-refundable.

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