3rd to 5th grade (completed)

ALTITUDE. MATTHEW 5:3-10

What is Green Country Camp?

Established in 1953 in the south Grand Lake town of Disney, OK, Green Country Camp is a joint ministry of Craig-Mayes and Rogers Baptist Associations in northeastern Oklahoma. GCC is a ministry of Southern Baptist churches that partner with the Baptist General Convention of Oklahoma to introduce people to a relationship with Jesus Christ!

RECREATION

Zipline, Laser Tag, Obstacle Course, Bungee Run, Disc Golf, Water Slide,

Swimming Pool, Basketball Court, Rec Field, Volleyball

Camp Speaker

Rob Dunning

Camp Worship Leader

Cody Sanders

Camp Night Time

Devotion Leader

Leah Hancock

$150

BEFORE JUNE 1ST.

AFTER JUNE 1ST $160

SIBLING COST (TO SAME CAMP):

Before June 1st: $120

After June 1st: $130

Scholarship Application

Sponsor/Leader Registration

After completing this form, please follow the link to finalize payment and registration (please select 'Kids Camp' fund on payment page). Thank you!

CAMPER INFORMATION

Camper First & Last Name

Church normally attended

Birthday

Shirt Size

PARENT/GUARDIAN(S) INFORMATION

1. Parent/Guardian First & Last Name

Phone Number

Address, City, Zip Code

2. Parent/Guardian First & Last Name

Phone Number

Address, City, Zip Code

EMERGENCY CONTACTS

1. Emergency Contact (other than parent/guardian)

Phone Number

Relationship

2. Emergency Contact (other than parent/guardian)

Phone Number

Relationship

Vital Infotmation

MEDICAL RELEASE

Camper's Physician Name

Phone Number

Date of last Tetanus immunizations

Date of last Diphtheria immunizations

If you are sending medication to camp, parents/guardians must fill out the following Medication Administration Authorization Form. If you are not, you can type N/A and continue to Insurance Information.

Are you sending medication to camp?

Yes

Camper's Age

Camper's Weight

Diagnosis or reason for medication

List of Medications, Dose and Times to be given:

INSURANCE INFORMATION AND ASSIGNMENT

Name of Insured

Address, City, Zip Code

Insurance Company

Employer

Policy #

Group #

Cert. #

Mail claim to (Address, City, Zip Code)

DISCLOSURE & AGREEMENT

I hereby, give this church and Green County Camp permission to give over the counter medication to my child. These may include, but are not limited to Tylenol, Ibuprofen, Pepcid, Tums, or Benadryl. I do not need to be contacted before any medication is given.

Agreement

I give permission

I need to be contacted first

Signature Parent/Guardian

I give my permission for my child to attend camp with and will not hold this Church or Green Country Camp (Green Country Baptist Assembly) responsible for any accident that may occur. I also give permission for my child to receive medical treatment or attention in case of emergency or illness while traveling &/or while under the supervision of above referenced Church, sponsors, &/or camp staff. I further give full authority to this Church’s staff & sponsors to discipline my child as may be deemed necessary. If my child’s behavior is such that it may endanger the happiness or the safety of the entire group, the sponsors have my permission to send my camper home after notifying me of their intention. I promise to pay the cost of the return trip should this action become necessary. I expressly understand & acknowledge that during the course of the camp photographs &/or video footage of my child may be taken & I hereby give permission for such photographs or videos to be used on the camp website &/or for promotional materials for the camp. *** I also agree to check for head lice within 24 hours of attending camp.

Signature Parent/Guardian

Date

3rd to 5th grade (completed)

ALTITUDE. MATTHEW 5:3-10

What is Green Country Camp?

​

Camp Speaker

$150

CAMPER INFORMATION

PARENT/GUARDIAN(S) INFORMATION

EMERGENCY CONTACTS

MEDICAL RELEASE

INSURANCE INFORMATION AND ASSIGNMENT

DISCLOSURE & AGREEMENT