Winter Camp Registration

Search:
About Us

Mission Statement

Western Buckeye Christian Service Camp is a Christian organization that provides facilities and resources for individuals, families, and organizations.
Verse of the Day
There is no fear in love. But perfect love drives out fear, because fear has to do with punishment. The one who fears is not made perfect in love. — 1 John 4:18 (NIV)

You can register online or download the registration form here and mail it in. If you don’t want to include the credit card information online you can simply send a check to the camp along with a print out of the form.

Registration Form 2010 | Only One camper per from.

Campers Name(required)
Camper's Birthdate(required)
Male or Female
Male Female
Age
Carbon Copy This To Myself
Email(valid email required)
Camper's Address(required)
Camper's Email(valid email required)
Home Phone(required)
Emergency Number(required)
Parent/Guardian#Male#Female#(required)
Camper's Pick-up Person(required)
Church Name & Town
Week of Camp|(one week for form)|(required)
Church pays
Church Representative
A MINIMUM OF $50 IS REQUIRED FOR REGISTRATION FEE AND IS NON REFUNDABLE.
Card Type
Credit Card Info
Credit Card Expiration Date
Amount to Charge at this time.Amount to Charge for payment, at this time.
Electronic Signature
Are the camper's immumizations up to date||
yes no
Can your child have tylenol?
yes no
Allergies
Food Allergies
Current prescription/non-prescription drugs or medications ( All medications must be turned in to the nurse and be labeled with the camper's name, the drug name and the dosage and frequency of dispension. Original prescriptsion bottles are best.
Date of last tetanus shot
Physical limitations
Health Insurance co.
Pearent/Guardian holding coverage
Employer
Group Policy #
City / State
Terms of AgreementI, ► Give permission for my child to participate in all activities during this week or session of camp except as noted under physical limitations above. ► Acknowledge that the insurance carried by the camp is a secondary coverage, covering medical needs only beyond what my personal insurance will cover up to a maximum of $2500.00. ► Give permission for the Nurse or Camp Manager to secure routine non surgical medical care for my child while at tending camp. ► Give permission to the physician selected by the Camp Management to hospitalize, secure proper treatment for, to order injections, anesthesia or surgery for my child. I understand that every effort will be made to contact me be fore any emergency procedures are undertaken. ► Release the Camp from any responsibility other than normal supervision and care. In case of accident, I will not hold the camp, or it’s faculty, staff, management or trustees liable unless guilty of gross negligence in regard to the safety and welfare of the camper. I certify that all information on this form is correct to the best of my knowledge.
For submiting electronicly you must innital. By innitaling you agree to the terms listed above.(required)

cforms contact form by delicious:days

Comments are closed.

Providing facilities and resources for individuals, families, and organizations.

Winter Camp Registration

Search:

About Us

Verse of the Day