Online Registration

Cancel

 

General Information

 

 

Purchasers name (Full name on credit/debit card):

(This field is REQUIRED in order for your registration form to be associated with your payment receipt.  Please fill in the purchasers full name or your registration may not be completed successfully.)

 
Campers Name:         Male:
Female:

Birthdate:

   
Mailing Address:    Age:    
Grade Entering:     Home Phone:    
Church you are registering with, if any:   Cell Phone:   
  Request for Cabin mate. (Up to 2):

 

Camp you will be attending

 

Which Camp will you be attending?

   
(If applicable) Buddy I & II buddy's Name: Male:  Female:

 

Please check if the camper has or is susceptible to the following

 

Heart Murmur:

High Blood Pressure:

Heart Disease:

                 

Epilepsy/Convulsions:

Asthma:

Recent Head Injury:

Diabetes:

Ear Infection:

Hay Fever:

 

Does your child have any current medical problems or restrictions on activities?

  

May your child be given Advil or Tylenol?

  

If yes, then explain:

  

Camper Allergies:

 Poison Ivy Mosquitoes Bees Penicillin Other: 

Health Insurance Company and Policy #:

  
   

All medicine is to be left with and dispensed by the first aid caregiver!

 

       In case of emergency, I hereby give permission to the physician selected by the camp management to give treatment and medication to my child. I understand every effort will be made to contact me before treatment is given. I hereby give my child permission to take part in the recreational program, swimming and other activities.  I hereby release the camp from any responsibility other than normal supervision and care. In case of accident, I will not hold North Georgia Christian Camp or its staff members, management or officers liable unless guilty of negligence.

 

By submitting this form you agree that all the information entered into the form is accurate and true and that you agree with the terms and conditions set forth by

North Georgia Christian Camp.

 

 

Cancel