Summer Camp Registration 2025

Registration Step 1

Camper Name

This address will receive a confirmation email

Gender

Male Female

Birthdate

Phone

Address

Baptized?

Yes No

Home Congregation

First Time Camper ?

Yes No

Medical Questionnaire (Step 2)

Any Allergic Reactions, including food alergies?

Taking Medications? Yes No

If Yes,

How Often:

Medication Name:

Any Physical Limitations?

Date of Last Tetanus injection

Medical Information

Physician Name:

Physician Phone:

Insurance Company

Policy Number:

Policy Holder Name:

Insurance Phone Number:

Emergency Contact

Name:

Relationship

Contact Phone Number

Authorization

By typing my name in the box below, I hereby give permission for the camper named above to attend BurntCabin Christian Camp.
I give my permission for the Camp Director to authorize routine treatment of non-emergency care in cases of injury or illness. In any emergency, I understand that every reasonable effort will be made to contact me. In the event I am not reached promptly, I hereby give my permission to the Physician selected by the Camp Director to hospitalize and secure proper treatment, including surgery, for my child at my expense to the extent not covered by the camper's insurance. I release Burnt Cabin Christian Camp and all camp personnel from any liability arising from all routine or emergency care.

Name

Today's Date

Summer Camp Registration 2025

Description

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