Summer Camp Registration Form 2024

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Complete and send a minimum, non-refundable $50 deposit or full payment to: Camp Brethren Heights Inc., 9478 Brethren Heights Rd., Rodney, MI 49342

Email *

Last Name *

First Name *

Gender *

Male

Female

Name Camper prefers *

Birth Date *

Incoming Grade *

Age During Camp *

Mailing Address *

Parents'/Guardians' names *

Family Email *

Home phone

Work phone

Parent's cell *

Church Membership

Pastor

Camp Program Requested *

Camp Dates Requested *

Cabin mates requested (full name of ONE friend of similar age/grade attending same program)

Who to call if parent/guardian is not available *

Relationship to camper *

Home phone

Work phone

Cell phone *

Parent/Guardian Authorizations

In signing this application, I certify that all information is correct, and my child/ward is in good health and may participate in camping activities. I give consent for camp officials to act in any emergency in the best interest of the health and welfare of my child/ward. Should it become necessary for him/her to return home during the week because of illness, accident, homesickness, or conduct, I will abide by the camp’s decision in this matter and provide transportation. I recognize that certain hazards and dangers are inherent in camp events and programs. I understand, also, that although the camp has taken precautions to provide proper supervision, instruction, training, and equipment for each activity, it is impossible for the camp to guarantee absolute safety. I further understand that my child/ward shares responsibility for his/her safety and I have instructed my child/ward in the importance of knowing and abiding by camp rules, regulations, and procedures for the safety of camp participants. Further, I waive any claim that may arise against the camp and/or employees and volunteers because of participation in the program, except for those that are a direct result of gross negligence of the camp or its employees.

If you agree to the statement above type your name and date below. *

We now send out all camper’s confirmation packets, welcome letters and additional forms electronically 2 weeks prior to their selected camp. Please use current email you want a packet sent to. *

Does your child need a Camp Scholarship Application? *

If YES, please visit the camp website to download and fill out the Campership Application or fill out the Google Form (in the Registration For Camp Tab) and send it in with your registration.

Yes

Multiple Children Discount? *

Yes

If Yes Sibling(s) names:

Bring a Friend Discount? *

Yes

If Yes, Friend's name:

Camper Photo & Video Permission *

I permit camp photos, video and audio of activities or interviews that may include my child to be used in camp promotion without liability or remuneration.

I prefer my child NOT be permitted in camp photos, video and audio of activities or interviews.

Camper Profile

The following questions will help us ensure a quality camp experience for your camper. Talk with your child and get their thoughts as you complete these questions. Attach additional pages of helpful information.

How did you learn about Camp Brethren Heights? *

I/We chose Camp Brethren Heights because *

Will this be your child's first time away from home for this length of time? *

Yes

How many Years has your child been a camper? *

At Brethren Heights? *

How would you describe your child? *

What are some of your child's hobbies, talents and/or special interests? *

How does your child relate (living, playing, working) to others in group situations? *

How well does your child make friends? *

Are most of your child's friends *

Same age

Younger

Older

What special needs does your child have(behavioral, medical, emotional, dietary, activity restrictions, etc.)? *

What is your child looking forward to the Most at Camp? *

What is your child looking forward to the Least at Camp? *

When it come to waterfront activities, my child is: *

Swimmer

Non-Swimmer

Has your child experienced any tragedies/deaths/ in recent years? Has this affected their behavior/attitude? *

What are YOUR hopes for your child's camp experience? *

Please list drivers that your child is allowed to travel with (this includes any driver that he/she knows): *

Please list drivers that your child may NOT be released to/allowed to travel with: *

How will you be paying your deposit? *

Check

PayPal

Venmo

Is there anything else you would like to mention that was not covered elsewhere?

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of Camp Brethren Heights Inc.. Report Abuse

Forms