Camper Registration Form

Campers and parents/legal guardian, please read and sign accordingly on back of this registration form.



Older Youth Camp forms due May 1 ... Children's Camp forms due June 30 .... Younger Youth Camp forms due June 7

    Grade Completed  _______

Name:  _______________________________________________                                                 Please Check T-shirt Size:

Complete Mailing Address:                                                                                                                                    Youth ____ S  ____ M  ____L    

_____________________________________________________                                                 Adult  ____ S  ____ M  ____ L

City:  _______________________________ Zip Code:  __________                                                Other $________ is $3.00 more

Name of Parent or Guaradian ________________________________________________________________________________________

Home Phone:  ________________________ Work Phone:  _______________________________  Cell Number:  _________________

Emergency Phone Numer is _______________________  Home ______________________  Work ____________________________

Name of your Family Doctor ___________________________________________________  Phone Number ____________________

HEALTH HISTORY  (please circle/check appropriate ones)

Frequent Colds           Athlete's Foot      Epilepsy       Ear Infection       Diabeles      Fainting      Bed Wetting       Sleepwalking        Kidney Trouble

Rheumatic Fever        Convulsions       Bronchitis     Snusitis       Asthma            Stomach  Upsets       Heart Problems        Frequent Sore Throat

 ALLERGIC REACTION TO:  Bee Sting ___  Penicillin ___ Serious Ivy ___ Oak ___  Sumac Poisoning ___ Other ______________________

Recent Injuries:__________________________________________________    Recent Illness:  ___________________________________

Attach additional sheet/s if needed.

Details of above or additional information______________________________________________________________________________

Please notify the camp if this camper has been exposed to any communicable disease during the three (3) weeks prior to camp attendance.


HEAD LICE CHECK:  Checked by _________________  Free  ___ Found ___ 

If lice/nits are found, camper will have to go home.  Camper may return when clear of lice/nits.

Birth Date _______________   Age  _______________    Sex   _____________  Height _____________  Weight ______________

If your child is on regular medication/s, please list the drug, dosage, and time to be taken.  _______________________________________


Child's name and doctor's directions for use must be on all Medications.

DURING CAMP, ALL MEDICATION/S GOES TO THE CAMP NURSE.  This includes aspirin, Tylenol, etc.

I give my permission to the camp nurse to provide to the camper first aid, provide minor health care as needed, and administer any medications listed above.                                                   

                                                                                                 (Parent or Guardian) ___________________________________________________

I give my permission to the camp administration to secure PROFESSIONAL MEDICAL AID as needed.

                                                                                                  (Parent or Guardian) ___________________________________________________








                                                                                                    Nodtary Public:______________________________  Date: ______________________

++ The reason we ask for this to be notarized is in the event of an emergency requiring a trip to the emergency room, it will allow for quicker teratment of your camper.  This can be notarized at most if not all, banking institutions.

Camper attends and/or is a member ______________________________________________________

What church are you with at camp?       ____________________________________(If a First Baptist Church, what town?)________________

Signature of pastor, deacon or clerk      _____________________________________________________

I give my permission for this camper to participate in the activities of the camp including swimming except the activities as specified.


___________________________________________________________(Parent or Guardian) __________________________________

Please sign below that you have read the Camp Rules & Guidelines for Fellowship Baptist Associaiton and, as best you are able, understand them.  When you sign his paper you are agreeing TO DO YOUR BEST to follow the rules.  You know -- your pastor and parents know -- that if you break the rules, you will be sent home.

There are 3 BIG THINGS to remember:  1) Be where you are supposed to be, when you are supposed to be there, and doing what you are supposed to do.  2) Always be on time and take any changes that may happen well.  3) Have a good attitude and be willing to learn.

______________________________________ (Camper sign here)   _______________________________ (Signature of Parent or Guardian)

PHOTO RELEASE -- BAPTIST RIDGE CAMP --  Please sign below if you do not want Fellowship Baptist Association to take/use photographs of me with or without my name for any lawful purpose, including for example, such purposes as publicity, illustsration, advertising and Web content.

______________________________________ (Camper sign here)  _______________________________ (Signature of Parent or Guardian)

                                                                                                                                      _______________________________ Date