EmailMe Form - Next Gen 2017 Camper Registration Form

Camper's Name *

First Last

2016/17 Grade

Gender *

Date of Birth *

T-Shirt Size *

Parent/Legal Guardian's Name *

First Last

Phone *

### - ### - ####

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

Email *

Alternate Emergency Contact *

First Last

Phone *

### - ### - ####

Relationship *

Does the camper have any siblings who will be attending the same camp? *

Yes

No

If yes, please list name(s)

Does the camper have any allergies or medical conditions (Drug, Food, Environmental) *

Yes

No

If yes, please list and explain

Will the camper need to take medication while at camp? *

Yes

No

If yes, please list and explain

Date of campers last Tetanus shot (year) *

PARENTS: Please review the below with your child.
CAMPER CONDUCT:

Will you, the camper, conduct yourself in a manner that is respectful toward counselors, staff members, & your fellow campers & follow all rules set by your camp leadership & the facility? *

Yes

No

Do you, the camper, understand that you may be sent home for any inappropriate contact or behavior with another camper or counselor? *

Yes

No

Health insurance carrier: *

Policy no.: *

I give my permission for my child to participate in New Life Camp sponsored by New Life Church of Jesus Christ. I understand that all activities will have adult supervision and I will receive notice of any accident.
I give the adults in charge permission to seek emergency medical care if I cannot be reached and hold New Life Church of Jesus Christ and the adult leaders harmless if my child becomes ill or hurt. I give permission to the New Life Camp Staff to use pictures/video of me for the purposes of promoting the camp experience.

Parent/Guardian Type Name Here For Electronic Signature *