Church of God, Faith of Abraham Camp Registration

Thank you for your interest in attending the our camp. To reserve your seat, please fill out the information below. By filling out and returning this form you agree to the statements below.

1. I know that guys can’t be in girls-only areas, and girls can’t be in guys-only areas.

2. I will not possess, use, or sell alcohol, tobacco, or illegal drugs.

3. I will not use electronic devices to play games, videos, music etc unless part of a presentation or other approved activites.

4. I will not mess with anyone’s body, mind or belongings.

5. I will show up at all meals, classes, sessions and activities and do my best to be on

time.

6. I will report any injury to the nearest adult immediately.

7. I realize they are called undergarments for a reason, I will keep them and their

contents covered. Yes, that means both guys and girls.

8. I will treat camp staff with respect, cooperate with them, and obey all rules and

expectations.

9. I will try to have fun, and I will stay safe by following these 8 simple rules.

First Name *

Last Name *

Age *

Address 1 *

Address 2

City *

State *

Postal Code *

Email Address *

Days Attending *

For Parent/Guardian:

I hereby consent to any medical treatment deemed necessary during the attendee’s stay. I give permission to camp staff to administer over the counter drugs or medical attention as they see fit. I assume risk and responsibility for any injury or liability resulting from the attendee’s participation, including and athletic activity. I also consent to the attendee being filmed and photographed for possible use in a publication, web site, or video without compensation.

Date of last Tetanus Shot *

Do you have Health Insurance? *

Insurance Policy number: *

Health Insurance Provider *

Group Number *

Please list any medications you are taking. *

Please list any alergies *

Is the attendee able to administer their own medications? *

Please list any other medical conditions the staff needs to be aware of. *

Emergency Contact Name *

Emergency Contact Number *