Online Camper Registration

GENERAL INFORMATION
Please use a separate form for each camper. If a form item does not apply, please enter "NA".
PARENTS: Please complete all information.
Name of Camper:
Address:
City:
State/Province:
Zip:
Phone:
Email:
Gender:
Birth Date:
Age:
Grade:

(completed as of May 2019)

Returning Camper?
PARENT INFORMATION
Parent/Guardian Name:
Parent/Guardian Phone:
Phone #2:
Insurance Company:
Group #:
If Parent/Guardian cannot be reached:
Relative/Friend Name:
Relationship:
Phone:
Phone #2:
CHURCH INFORMATION
Home Church:
Pastor's Name:
Church Address:
City:
State:
Zip:
CAMP CHOICES
Camp Choice:
Camp Dates:
Please list one friend only to bunk with:
* Please fill out the above to guarantee a bunk with a friend
CAMP FEE WORKSHEET (TO BE COMPLETED BY PARENT)
Listed camper fee:
$
Church Portion Indicate amount
your church agrees to pay camper
$
Parent's portion of camper fee:
$
3% PayPal/Credit Card Processing fee:
$
$10.00 Late Registration Fee:
$
TOTAL
$
HEALTH RECORD
Camper Name:
Please Check
Yes
No
Overall good health and able to participate in all activities.
Significant illnesses or injuries (ie. Asthma, diabetes, heart problems, etc.)
Special considerations (A.D.D., bedwetting, sleep walking, prone to homesickness, etc.)
Please Explain:
Allergies (i.e. medications, bee stings, food, other)
Please List:
Medication (list and include dosage, frequency, and times)
The camp has permission to administer Tylenol, Ibuprofen, Over the Counter cold or allergy medications, to my child as needed.

FOR PARENTS

In case of medical emergency, I understand that every effort will be made to contact parents/guardians of campers. In the event that I cannot be reached 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 herein. Parents or guardians are responsible for the insurance coverage while their child is attending camp. Any outside charges incurred relating to sickness or illness by your camper will be billed to parents or guardian.

I consent to have my child participate in the activities of Crystal Springs Baptist Camp, and certify that I will hold Crystal Springs Baptist Camp, its directors, employees or agents harmless from any and all liability and claims arising out of participation in or in the connection with the program of Crystal Springs Baptist Camp. I hereby certify that the above information is correct. I also give permission for the use of photographs or video including my son or daughter to be used in camp publicity.

I grant permission for the camp administrator to take an inventory of my child’s belongings in the presence of my child and two adult staff members if there is reason to believe that the belongings pose an immediate risk to the health or safety of other campers or staff.

We strive to accommodate campers with food allergies to the best of our abilities, but our kitchen facility regularly processes foods that pose a potential risk of cross contamination (gluten, dairy, nuts, etc). If you are sending a camper with food allergies of any kind, please notate this on your registration. If the camper has severe allergies to one or more food items, you may consider bringing personal food for the week to ensure no cross contamination will occur.

IMPORTANT!

Parent Initial

Parent, Please check this box and initial to indicated that you have read, understand, and agree to the previous statement regarding food allergies, medical emergencies, insurance, publicity, and activity participation.

FOR CAMPERS

1) Release of Responsibility: In consideration of the opportunity to participate in the activities, I will not hold Crystal Springs Baptist Camp, its directors, employees, or agents responsible or legally liable for any injuries to the person or property or the results thereof, incurred and suffered as a result of my participation in any of the activities or programs at Crystal Springs Baptist Camp.

2) Willingness to Follow Instructions and Rules: I understand that Crystal Springs Baptist Camp will provide the necessary safety equipment and personnel trained to supervise participation in these activities. I agree to use the equipment as directed and to observe and follow all rules and guidelines for participation in these programs as directed by Crystal Springs Baptist Camp staff. I further agree that any failure to do so on my part may prevent my participation in these activities. I hereby certify that the above information is correct.

IMPORTANT!

Camper Initial
Camper, please check this box and initial to indicate that you have read, understand, and agree to the previous statements regarding Release of Responsibility and Willingness to Follow Instructions and Rules.
When you submit this form, you may be directed to our payment processing page. If you agreed to make the registration payment online, successful payment processing is required in order to complete the registration process. If you did not agree to pay online, then you can exit the payment process page and payment will be required at a later date. If you have any questions, please email us at office@csbcamp.org or call us at (701) 486-3467. Thank you!

Please Explain:

T-shirt Size (Fall Retreat only):