Return to Dunes Bible Camp Registration Page

Dunes Bible Camp 2010 Youth Camps’ Registration and Medical Information

Camper’s Name ____________________________________Age during camp ________________

Birthday ______________________________ Boy ____ Girl ____ Grade next fall _____________

Home Church ____________________________________________________________________

Parent’s Names ___________________________________________________________________

Mailing Address ___________________________________________________________________

City_________________________________________State___________ Zip__________________

Home Phone _______________________________Cell Phone # ____________________________

Emergency Contact Name and Phone #__________________________________________________

Insurance Co. Name & Address ____________________________ Policy / ID# _________________

Family Physician________________________________________ Phone ______________________

Pre-existing medical conditions, allergies, disorders, etc. _____________________________________

List any prescribed medications. ________________________________________________________
Note: Prescriptions must be in original containers and turned in at registration.

Immunizations are current    Yes ___    No____

Initial if your child can receive over-the-counter medications (i.e. Tylenol, Advil, etc.) _____________
============================================================================
CAMP INFORMATION
Please sign me up for (circle): Primary Camp, Junior Camp, Junior High Camp, High School Camp
Junior Camp or High School Camp “Cabin Buddy” request:

(Please choose only one or two cabin mates. They should also choose you.)

1. ________________________ 2. _____________________ Cabin Leader request: ___________________

PAYMENT INFORMATON

___ Check enclosed (Payable to Dunes Bible Camp)

Charge my: ____ VISA ____ MC Exp. Date ___________ Card # _________________________

Name on Card_________________________________ Signature: __________________________________

PARENTAL RELEASE & PERMISSION

A. The purpose of the Dunes Bible Camp is to provide programs and/or a facility to assist Christians in bringing the gospel of Jesus Christ to every camper and to help Christians grow in their faith.

B. Any participant that engages in illegal activities, endangers others, or refuses to conform to the camp rules is subject to being sent home immediately. The parents or guardians will be responsible for transportation and to forfeit camp fees. Modesty in dress is also required. The camp reserves the right to determine the standard of attire.

C. My child has the permission to participate in all activities on or off the grounds. I recognize that The Dunes Bible Camp (DBC) has taken extensive safety measures; however, I also recognize that DBC cannot insure or guarantee that the participants, equipment, grounds, and/or activities will be free of accidents or injuries. I will defend DBC, its staff, employees, volunteers, and its Board of Directors from any claims of liability arising from my/my child’s participation in the DBC camps or activities.

D. I give permission for Dunes Bible Camp to use any photo or video of my child for DBC publications or promotion/advertising. I release my right to any kind of remuneration for said photos or videos.

E. In the event that I cannot be reached in an emergency, I give permission to the physician selected by the camp director to hospitalize, secure proper treatment for, and order injection, anesthesia, X-rays, routine tests, and/or surgery; to release any records necessary for insurance purposes; and to provide or arrange necessary related transportation for my child.

F. I hereby authorize the directors and staff at Dunes Bible Camp to act for me in their best judgment in any emergency requiring medical attention. I have made note of any medical or physical problems which might affect my child’s ability to safely participate in the camp.

Parent/Guardian Signature:_________________________________ Date:________________


Parent/Guardian Signature:_________________________________ Date:________________

(By signing, I agree to respectfully comply with all camp rules and to accept camp leadership authority.)

Please copy and complete Consent Form. Thank YOU!

Mail registration form and payment to:
Dunes Bible Camp
23515 Pacific Way
Ocean Park, WA 98640