CHBC 2023 Camp Registration

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Name of child *

DOB *

YYYY

Parent(s)/Legal Guardian(s) *

Primary email address *

Primary phone number *

Home address *

Emergency contact name and phone number *

T-shirt size *

Youth S

Youth M

Youth L

Adult S

Adult M

Adult L

Adult XL

Other:

I hereby give permission for the above-named child to participate in activities at Camp 

ToknowHim with Callie Harbin Baptist Church. This includes all activities including travel and/

or lodging) unless otherwise limited below. I understand that reasonable precautions will be 

exercised by the adults chaperoning this event and that adults will adhere to Safe Church policy 

at all times. This permission shall only remain in effect for June 9-12, 2023

I hereby give permission for my child to ride in the charter bus designated by the church. 

In addition, I understand that my child may be photographed or recorded on video during the 

course of camp. By initialing below I provide consent for their image to be used in either print, 

electronic, or video form for the promotional purpose of future retreats and youth group 

activities.

Initials of Parent/Guardian

Please list any limits to activities for above named child *

What is your child’s swimming level? (doesn’t know how to swim, beginner, advanced)
*

Does not know how to swim

Beginner

Advanced

Other:

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