Online Camper Registration

"*" indicates required fields

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*

First Last

Mailing Address*

Street City State Zip

Phone*

Email*

Sex

Male

Female

Birth Date*

MM slash DD slash YYYY

Age

Grade

(completed as of May 2025)

Returning Camper?

No, this will be my first time camping at Crystal Springs Baptist Camp.

Yes, I have camped at Crystal Springs Baptist Camp before.

Parent Information

Parent/Guardian Name*

First Last

Parent/Guardian Phone*

Parent/Guardian Phone #2

Insurance Company*

Group #*

If Parent/Guardian cannot be reached:

Relative/Friend Name*

First Last

Relationship*

Relative/Friend Phone*

Relative/Friend Phone #2

Church Information

Church Name*

Pastor's Name*

First Last

Church Address*

Street City State Zip

Camp Choices

Camp Choice

Camp Start Date

MM slash DD slash YYYY

Camp End Date

MM slash DD slash YYYY

This field is hidden when viewing the form

Registration Due Date

MM slash DD slash YYYY

Registration is due on or before 02/07/2025. After this date, a late fee will be added to the final payment.

Please list one friend only to bunk with

First Last

* 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

Late registration fee

Arctic Blast Registration

TOTAL: $0.00

* A late fee is being applied due to the registration happening after the camp's registration due date.

Health Record

Camper Name

First Last

Overall good health and able to participate in all activities.

Yes

Significant illnesses or injuries (ie. Asthma, diabetes, heart problems, etc.)

Yes

Please Explain

Special considerations (A.D.D., bedwetting, sleep walking, prone to homesickness, etc.)

Yes

Please Explain

Allergies (i.e. medications, bee stings, food, other)

Yes

Please List

Medication (list and include dosage, frequency, and times)

Yes

Please List

The camp has permission to administer Tylenol, Ibuprofen, Over the Counter cold or allergy medications, to my child as needed.

Yes

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.

I understand that sex-specific changing areas, sleeping areas, restrooms, and showers are to be use by members of the designated biological sex only.

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 Agreement*

I have read, understand, and agree to the previous statement regarding food allergies, medical emergencies, insurance, publicity, and activity participation.

Parent Initial*

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!

Parent Agreement*

I have read, understand, and agree to the previous statements regarding Release of Responsibility and Willingness to Follow Instructions and Rules.

Camper Initial*

Payment Preference

I am paying for the registration online.

I will pay off-line at a late date.

A 3% PayPal/Credit Card Processing Fee is added to the registration.

Payment Method*

MasterCard

Visa

Supported Credit Cards: MasterCard, Visa

Card Number Expiration Date Security Code Cardholder Name

Name

This field is for validation purposes and should be left unchanged.

The registration process is complete after we receive payment for the registration. For online payers, that means successful payment processing from our online payment processor. For offline payers, that means sending a payment to Crystal Springs Baptist Camp by the start of the selected camp. If you have any questions, please email us at office@csbcamp.org or call us at (701) 486-3467. Thank you!

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