K-1st Day Camp Registration

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Saturday 06/25/2022

Email *

Camper Name *

Parent Names/Cellphone *

Mailing Address *

Is there anyone who is restricted from picking up your child? *

Payment for K-1 day camp is $35. Please select how payment will be made. *

Online Payment

Mailed

Paid in person on registration day

Other (such as church paying for child, etc)

Required

Grade Entering Fall of 2022 *

T-Shirt Size *

Youth Small

Youth Medium

Youth Large

Adult Small

Adult Medium

Adult Large

Adult X-Large

Adult XX-Large

Adult XXX-Large

Home Church *

Baptized? *

yes

List any medical conditions or known allergies in detail. *

Please list all prescription medications, dosages, and times taken.

Tetanus Booster up-to-date? *

yes

Camp nurse has permission to give following medicines if needed:

Yes

TYLENOL

IBUPROFIN

COUGH DROPS

BENADRYL

ANTACIDS

TOPICAL OINTMENTS

SUNSCREEN, ALOE VERA

Clear selection

Insurance Provider & Policy # *

Dietary restrictions and/or food allergies: list all that apply for FOOD only as this information will be given to the kitchen staff. *

I understand that all of the registration fees need to be mailed to the camp by May 30th, 2022 to not be considered late; payment may also be sent via PayPal through the camp website. All fees after May 30th, 2022 will be considered late. These fees may be sent after the date, or upon your arrival ($25 late fee) *

I understand

In the event of an emergency where medical treatment is required, I GIVE MY PERMISSION TO GASCONADE CHRISTIAN SERVICE CAMP staff, or church youth sponsor to authorize any and all medical services and/or procedures, including surgery, if necessary, from a licensed physician. Gasconade Christian Service Camp will attempt to notify the parent/legal guardian prior to the utilization of such services. I, the UNDERSIGNED, agree to hold Gasconade Christian Service Camp harmless against any claim of liability or loss for personal injury, property damage, or economic loss which may arise as a result of the applicant’s participation in the activities of Gasconade Christian Service Camp. I will in no way hold the camp manager, nurse, or staff personally responsible for any accident or contraction of any illness/virus that might befall the applicant. Further, I will not hold the aforementioned personally responsible for any medical treatment administered to the applicant. I also give my permission for the camp to use video/photography of my child for promotional purposes. By submitting this form and clicking 'I Agree' below, I give my consent. *

I agree

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