2009 Camper Registration

ATTENTION!: This form is meant for you to fill out, print off, and mail to camp. You have NOT fully registered by simply filling out this form online.

*All fields are requirred.

Please provide the following contact information:

First Name
Last Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Work Phone
Home Phone
E-mail

Please describe yourself (camper):

Full Name
Date of Birth
Sex Male Female
Age
Choose the camp:


I would like to room with ... ? (Please list only one)

How do you plan to arrive at Camp?
I need a ride from the local Covenant Church
My parents plan to bring me.

I plan to load the bus in:

Thief River Falls
Bemidji
Roseau
International Falls
Not Applicable

Grade entering into...... this Fall.

3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade

Please indicate if your child has problems with any of the following:

Asthma
Diabetes
Seizures
Life Threatening Allergies
Long Term Medication
Mental Health Issues
Attention Deficit Disorder

Activity Restrictions/ Special Needs

Medications Being Taken

Immunization Record

Other Health Concerns

Health Insurance Company

Insurance ID #

Group #

In Case Of Emergency Notify

Emergency Contact Phone #

CONTRACT:

  • I understand that every effort will be made to protect and safeguard all campers.  I agree not to hold Bluewater Covenant Bible Camp liable for any illness or mishap from any cause whatsoever.
  • I also give the camp full authority in dealing with problems of discipline.  I understand that any camper disregarding camp rules is subject to being sent home with no refund of camp fees.  I understand that any camper who willfully destroys property will be held responsible and charged accordingly.
  • In case of emergency, if I cannot be contacted, i hereby give permission to the physician selected by the Camp Director to hospitalize, secure proper treatment for and to order injection, anesthesia or surgery for my child, as named above.
  • I have disclosed to Bluewater Covenant Bible Camp all medical issues and medications that my child has or is using.
  • I give Bluewater Covenant Bible Camp permission to use comments, photos and videos of the the camper named above in its promotional materials.

I agree to abide by this contract and understand the consequences.

Yes
No

Enter the date :

AFTER SUBMITTING THIS FORM, YOU WILL BE ABLE TO PRINT OFF A REGISTRATION PAGE. PLEASE SEND THE PAGE, ALONG WITH A NON-REFUNDABLE $25 CHECK TO BLUEWATER COVENANT BIBLE CAMP.

Bluewater Covenant Bible Camp, 38400 Bluewater Rd., Grand Rapids, MN 55744