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 Grade Completed 3rd Grade 4th Grade 5th Grade Shirt Size PARENT/GUARDIAN(S) INFORMATION EMERGENCY CONTACTS MEDICAL RELEASE 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?
List of Medications, Dose and Times to be given: INSURANCE INFORMATION AND ASSIGNMENT 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. 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. Complete Registration & Proceed To Payment