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Camp Carmel Christ Centered Summer Camp

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Camp Carmel Online Registration, 2018

Your Email    
Name Birth Date
Address Male or female
Roomate Preference Grade This Fall
Parent's Name First Time Camper?
Parent's Home Phone    
Parent's Cell    
Parent's Email    
Home Church    
Pastor    
choose Week of Camp Attending:
    Sr High I
    Sr High II
    Jr High I
    Jr High II
    Junior I
    Junior II
    Winter Retreat
   
Emergency Contact Relation to Camper?
Emergency Phone    
Physician Name Physician City and State
Physician Phone    
  Allergies. Please indicate how severe, medication, dosage:    
Insect Bites:    
Medications:    
Food Allergies:    
Date of Last Tetanus Shot:    
What does camper take for pain:    
Other Medical Issues:    
  Camper is in good physical condition, free from any contagious diseases, and capable of participation in all camp activities except    
     
With the understanding the leaders of Camp Carmel have taken every reasonable precaution in preparing and planning every activity to ensure the safety of the above registered camper. I hereby release all of the leaders and the camp from liability due to a ny accident which may occur on or off Camp Carmel's property. Furthermore, Camp Carmel reserves the right to use pictures and video taken by Camp Carmel staff in promotional materials, on Facebook and the Camp Carmel website. IN CASE OF MEDICAL EMERGENCY, I hereby give my permission to the physician, elected by the Camp Carmel staff, to authorize proper treatment for, and order injections, anesthesia, or surgery for my child, as named herein. Furthermore, the information on this form is both true and correct to the best of my knowledge

Electronic Signature
By completing this form, you agree to the terms expressed above.

Name Date
Health Insurance Company Policy Number

Please make checks payable to Camp Carmel