Day Camp 2024

To be filled out ONLY by the parent or legal guardian of the camper

Camper Information

Each individual camper will need to apply separately.

Camper's Name

Gender

Male Female

Date Format: (mm/dd/yyyy) Grade is for Fall of 2024

Birthdate

Grade

Address

Mobile

Church

Who do you want to bunk with? (Please pick 1 or 2 CAMPERS that are within one year of your age)

T-Shirt Size

Child Size: YS (6-8) Child Size: YM (10-12) Child Size: YL (14-16) Adult Size:: S Adult Size: M

Parent or Legal Guardian's Information

Please fill out all fields that are applicable to the camper's family.

Parent or Legal Guardian's Name

Relationship

Parent or Legal Guardian's address is the same as the Camper's address?

Yes No

Parent or Legal Guardian's Address (if different from camper)

Parent or Legal Guardian's Cell Phone Number

Parent or Legal Guardian's Email

This address will receive a confirmation email

Additional Parent or Legal Guardian's Name (if applicable; if not, write N/A)

Additional Parent or Legal Guardian's address is the same as the camper's address

Yes No N/A

Additional Parent or Legal Guardian's address (if applicable

Additional Parent or Legal Guardian's Cell Phone Number

Additional Parent or Legal Guardian's E-mail Address

Release

This section must be completed by the Parent or Legal Guardian of the camper in order for this application to be acceptable.

I, the above named camper's parent or legal guardian consent to the camper participating in the Harvest Christian Camp (HCC) 2024 Summer Camp Season

I have read and agree to this release.

2. I agree that my child’s participation in Harvest Christian Camp is purely voluntary. I agree not to hold Harvest Christian Camp, House of Prayer Ministries, or any of its officers, staff, or volunteers liable or responsible for any loss or injury sustained arising in connection with his/her participation in Harvest Christian Camp activities.

I have read and agree to this release.

3. I acknowledge, for safety reasons, my child/teen cannot leave the HCC property without written permission on file in the office from the camp director. All campers under 18 yrs of age must be signed out by a parent/guardian or youth leader on the last day of camp.

I have read and agree to this release.

4. I, parent /guardian of the above named Child agree that Harvest Christian Camp shall have the right, but not the obligation to use my Child's photograph, likeness (including caricature, for their website, at any time and for any other purpose or materials the ministry deems necessary. The Child's name will not be used with the photos.

Yes Only in group photos please No, they cannot be included in any group photos.

Additional Emergency Contact Information

In a case of emergency attempts will always be made to the parent/guardian first. This extra contact is who you would want us to contact if we are unable to connect with you (parent/guardian).

Emergency Contact

Emergency Contact Phone Number

Emergency Contact's Relationship to Camper (For example: grandmother, uncle, neighbor)

Medical Information

Health Insurance Company

Health Insurance ID#

Does your camper have up to date vaccinations? (tetanus within last 5 years)

Yes; up to date No, not all are up to date

Does camper have any allergies (food, medication, environmental)?

Yes No

Does camper have any special mental, health, or behavioral problems?

Yes No

Does the camper have any functional limitations (walking, running, jumping, dancing, lifting, etc.)?

Yes No

Is the camper presently under physicians or psychiatric care?

Yes No

Is your child currently on any prescribed or over the counter medicines (including inhalers)?

Yes No

If you said yes to any of the above questions take the section below to give details to each question that was asked. (which allergies, names and doses of medication, mental, health or behavioral problems, functional limitations, and/or description of physician or psychiatric care. ) If you said no, then write N/A

List any recent illness, injuries, or hospitalizations. If no, then write N/A

Any additional medical information you feel would be important to share with us. If there are none, then write N/A

****ATTENTION****

Please send to camp with your child their inhaler and nebulizer, even if they have not used it recently. Also the camp will only have basic first aid and medication on site. Send to camp with your child any medicines you will expect them to need. We will only dispense over the counter medicine when absolutely necessary. Please note that all campers will have their heads checked for lice during registration. We desire for your child to have a healthy and safe camping experience.

I have read and will send to camp any medication my child may need during their stay.

Do we have permission to give your child Tylenol, Motrin, Ibuprofen, Pepto Bismol, Cough Drops, Loratadine (for Allergies), or Benadryl (for bee stings)?

Yes No

We have read and understand the forgoing requests and release. IN WITNESS WHEREOF, we have executed this request and release

Is the person filling this out the legal guardian? If you click yes you are stating that you are the parent or legal guardian for the camper you wish to apply for.

Yes No

Parent or Guardian's Signature. (Please type your first and last name as this will be your digital signature)

Day Camp 2024

Description

Please Fix the Following