Angel Tree BLBC Registration Form

Angel Tree BLBC Registration Form
Some conditions apply: One scholarship/week of camp per person, per summer, verification of incarcerated parent/step-parent is required.

If you are attending camp with Eagle Outreach, please fill out this form regardless of whether you are receiving an Angel Tree scholarship. Those attending with Eagle Outreach are exempt from the deposit. If you are with Eagle Outreach please contact them to register for camp!

Registration@EagleOutreach.org

800-383-5519 x810

A $40 deposit for day camp or a $75 deposit for resident camp is required to hold each child's spot. Once the registrar processes your form, you will be contacted about paying your deposit, which can be done either over the phone or by mail.

Scholarships are available to kids who currently have an incarcerated parent, those that have ever had an incarcerated parent (even if they are no longer incarcerated) Any child who also lives in the home with the child that has an incarcerated parent also qualifies.

If you have questions, please call our office at 360-357-8425 or email registration@blbcolympia.com
Camper Information
Camper's Name*

First NameLast Name
Second Camper's Name

First NameLast Name
Third Camper's Name

First NameLast Name
Camper's Address*
Mailing Address
City & State*
Zip Code*
Gender*

MaleFemale
Grade*
2025-26 school year
Age*
on the first day of camp
Birth date*
mm/dd/yyyy
Your email address*
example@example.com
Please select at least one of the following that applies to your child(ren) to verify they are eligible for a scholarship:*

Were registered for Angel Tree Christmas in prior yearsCurrently have a parent or step-parent incarcerated in a county, state, federal, or military facilityCurrently live in a household with an Angel Tree child who is attending campMy child will be attending with Eagle Outreach, but not on an Angel Tree Scholarship
Name of incarcerated parent (This is required to prove scholarship eligibility when reporting to Angel Tree)*

First NameLast Name
Facility/Prison*
This is required to prove scholarship eligibility when reporting to Angel Tree
Relation to Camper:*

MotherFatherOther
Select camp session:*

Junior Camp 1, (grades 4-8, June 21-26)Junior Camp 2 (grades 4-6, July 26-31)Junior Camp 3 (grades 4-6, August 2-7)Middle School Camp (grades 6-8, July 5-10)Sr High Camp (grades 9-12, July 19-24)Day Camp (grades 1-9)
If "Day Camp" was selected, please let us know which week of Day Camp you would like your child to attend.
Day Camp runs each week (Monday-Friday) from June 23 to September 29.
Is there someone attending the same camp that your child would like to be grouped with?
Is your child attending camp with Eagle Outreach?*

NO, my child is not with Eagle Outreach.YES, my child is with Eagle Outreach.My child will be attending with Eagle Outreach, but not on an Angel Tree Scholarship
Camper Health Information
List any Allergies
Additional Dietary Restrictions
With advance notice, we can provide: Gluten Free, Dairy/Lactose Free, OR Vegetarian/Vegan meals (but only one of those options at a time). Our menu can also be modified to exclude such common allergens as tree-nuts, peanuts and shellfish.
Is the camper's tetanus booster current?

YesNo
Specify if any of the following medications may be administered to your camper: Tylenol, Motrin, Benadryl, Tummy Soothers, Cough Suppressant, Anti-Itch Cream, Cold Medicine*

All listed may be administeredNone listed may be administeredOther
Will this camper be bringing any medications (over the counter or prescription) to camp?*

YesNo
You will need to bring a medication administration report (separate form) with you to camp. All medications must be in their original containers and turned in to the nurse.
Please explain any health concerns (asthma; diabetes; frequent colds, sore throat or ear aches; heart, kidney, or lung trouble; etc.):
Describe any behavioral concerns, activity restrictions, or anything else that would be helpful for the camp nurse and/or counseling staff to know.
Camper's Doctor
Doctor's Phone #

Area CodePhone Number
Health Insurance Company
Group #
ID #
Statement of Consent
"In case of injury or illness, I hereby give consent for hospitalization or medical treatment by a licensed medical doctor when deemed necessary by the camp for the welfare of said minor (or self, if 18 or older). I understand every effort will be made to notify parents or guardian of child. I acknowledge that I have given complete, accurate information and understand the camp's policies."

I agree with the above statement and am authorized to give such consent for each child listed above.
Initial here.*
Activities Waiver
Submitting a registration form to Black Lake Bible Camp implies agreement with the Activities Waiver (release of liability, assumption of risk and indemnification agreement) found on the Camp Policies page of our website and gives permission for each registered camper to participate in all camp activities.

Parents/guardians may deny participation in specific activities with the opt out form on this page.

I understand the activities waiver and I am authorized to give such consent for each camper listed above.
Initial here*
Media Release
I grant Black Lake Bible Camp permission to use comments, images, and/or recordings of the person/s you are registering in our promotional materials which may appear online or in print.
Please select one:*

I consent to the media releaseOpt-out: I do not want my child to appear in promotional materials from Black Lake Bible Camp
Contact/Caregiver Information

List the primary contact person/caregiver first, followed by up to 3 other people who may pick up the camper(s).
Caregiver Name and Information*
Who else is authorized to pick up this camper from camp? *
Anything else we need to know?
Prison Fellowship Ministries Media Release

Parent/guardian of the participating child hereby grants Prison Fellowship Ministries (“PFM”) its affiliates and agents, irrevocable permission to use, record, and reproduce the image and likeness of his/her participating child in any manner and in all media now or hereafter known, for any and all purposes (including advertising and promotional use), in perpetuity throughout the world, without restriction as to alteration. Parent/guardian and participating child give this consent with no claim for payment.
Please select one:*

I consent to the media releaseOpt-out: I do not want my child to appear in materials for Prison Fellowship Ministries
For Eagle Outreach Use Only
What is the campers t-shirt size?

Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult X-LargeAdult XX-Large
Transportation to camp:

Eagle Outreach will provide transportationCamper guardian will provide transportation
Transportation from camp:

Eagle Outreach will provide transportationCamper guardian will provide transportation
Should be Empty:

Angel Tree BLBC Registration Form

Camper Information

Camper Health Information

Statement of Consent

Activities Waiver

Media Release

Contact/Caregiver Information

For Eagle Outreach Use Only