Language
English (US)
Español
Email
*
example@example.com
Guest/Camper Name
First Name
Last Name
Event Name
*
Please Select
Man Camp
Junior Camp
Teen Camp 1
Teen Camp 2
Seasons
Start Date of Event
*
-
Month
-
Day
Year
Date
T-Shirt Size
*
Please Select
Child Small
Child Medium
Child Large
Adult Small
Adult Medium
Adult Large
Adult X Large
Adult XX Large
Adult XXX Large
Group Name
*
Please Select
Beech Park
Bible BC KY
Bible BC VA
Central BC
Edgemont Junior
Edgemont Teens
Enon
Fairview
FBC Pikeville
Floyd Rd Junior
Floyd Rd Teens
Friends BC
Friendship BC
Gethsemane
Grace
New Home
Southside
West Huntsville
Other/Individual
Gender
*
Male
Female
Any Food Allergies?
*
Yes
No
Food Allergies
Which Activity Waiver do you need?
*
Adult (aged 21 or older)
Minor (aged 20 or younger)
Back
Next
Adult Waiver
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Emergency Contact
*
First Name
Last Name
Emergency Phone
*
-
Area Code
Phone Number
Signature
*
Legal Name
*
First Name
Last Name
Submit
Back
Next
Minor Waiver
Camper Birthdate
*
-
Month
-
Day
Year
Date
Camper Age
*
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Parent/Guardian Name
*
First Name
Last Name
Street Address 2
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Phone
*
-
Area Code
Phone Number
Medical Info
Camper Covered by Family Health or Medical Insurance?
*
Yes
No
Insurance Carrier
*
Name of Insured
*
First Name
Last Name
Relationship to Camper
*
Insurance ID Number
*
Insurance Card
*
Browse Files
Upload copy of both sides of insurance card
Cancel
of
Immunizations up to date?
*
Yes
No
Currently Taking Medications?
*
Yes
No
Medications Taking
Dosage
Describe the dosage and frequency of administration
Chronic or Recurring Illness or Medical Condition
Activity Restrictions?
*
Yes
No
Health or Medical Concerns
*
Please describe any other health or medical concerns.
Emergency Contact
*
First Name
Last Name
Emergency Phone
*
-
Area Code
Phone Number
Signature 1
*
Parent/Guardian Legal Name 1
*
First Name
Last Name
Signature 2
*
Parent/Legal Guardian Name 2
*
First Name
Last Name
Submit
Should be Empty: