TEEN CAMP - 2026 REGISTRATION

Name

Gender

Boy Girl

Birth Date

Grade Entering This Fall

6th 7th 8th 9th 10th 11th 12th

Shirt Size (Size guaranteed if registering before June 1st)

S M L XL 2XL

This address will receive a confirmation email

Parent/Guardian's Email

This address will receive a confirmation email

Cell Number able to receive Text Message Alerts:
*This number is for in-house purposes only and will not be shared with 3rd parties. Texts will be sent in instances such as weather alerts, program information, and date reminders. By submitting this form you are authorizing consent to receive texts.

Cell Phone

Address

Parent/Guardian

Phone Number for Parent/Guardian

Secondary Contact in the event of emergency

Secondary Contact's Phone Number

Want to room with a friend at camp?

*Friend Requests are considered but not guaranteed.

Friend's Name

Medical/Liability Release

Medical Insurance Co.

Family Physician

Food Allergies

Yes No

If Yes, please list Food Allergies

Physical Limitations (Asthma, diabetes, allergies, etc.), and/or special instructions (Allergice to certain meds, rare blood type, wears contact lenses, etc.)

List ALL medication taken on a regular basis (Prescription meds MUST have a pharmacy label and name of doctor)

Any swimming, activity, or other restrictions?

Date of last Tetanus Shot?

Medical Release: "In the event that I cannot be reached in an emergency during the time period on this form, I hereby give permission to the physician or dentist selected by the leadership to hospitalize, secure proper treatment, and/or order an injection, anesthesia, or surgery for my son or daughter as deemed necessary."

Liabilty Release: "Every activity sponsored by this church is carefully planned and adequately supervised by mature adults. However, even with the best of planning and precaution, unforseen events can occur. By signing this form, the parent or guardian agrees to assume and accept all risks and hazards inherent in church-related social activites. They also agree not to hold this church or its employees or volunteer assistants liable for damages, losses or injuries to the person or property undersigned. The parents or guardians understand that they are signing for the minor listed on this form and the signature is for both a medical and liability release."

“By typing your name below, you are verifying that the statements and information provided are true and correct, and you are attesting to the validity of all contents within this electronic submission. By clicking on the submit button below, you are deemed to have electronically signed this statement. *

Payment

A Non Refundable Deposit of $60 is required to save your spot. You can pay here via credit card or stop in to First Baptist Colville's office and drop off cash or a check.

The Deadline to pay your Deposit is June 8th.

Payment

Name on Card

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

TEEN CAMP - 2026 REGISTRATION

Description

Please Fix the Following