CAMP WEST 2024

Secure Online Event Registration

Please make sure to read the Camp West Guidelines, Medical Treatment form, and Packing list, you can view each by clicking on the links or by downloading from the website.

JUNE 17-21, 2024

CAMPER INFORMATION

Registration Options*

REGISTRATION SENIOR CAMP (GIRLS) ($250.00)
REGISTRATION SENIOR CAMP (BOYS) ($250.00)
EARLY REGISTRATION SENIOR CAMP (GIRLS) ($230.00)
EARLY REGISTRATION SENIOR CAMP (BOYS) ($230.00)

Camper Name*

Email*

Phone Number*

Address*

Gender*

Male
Female

Date of Birth*

HOW MANY YEARS OF CHURCH ATTENDANCE?

CHURCH ATTENDANCE FREQUENCY*

DOES THE CAMPER HAVE THE HOLY GHOST?

YES
NO

PASTOR INFORMATION

PASTOR*

PASTOR'S FIRST/LAST NAME (if not mentioned above)

CHURCH NAME

CITY OF CHURCH

PASTOR OR CHURCH PHONE

PASTOR'S EMAIL

MEDICAL INFORMATION

IS CAMPER CURRENTLY UNDER DOCTOR'S CARE?*

PLEASE EXPLAIN DOCTOR'S CARE

DOES CAMPER CURRENTLY TAKE MEDICINE?

WHAT TYPE OF MEDICINE?

IN THE PAST 3 MOTHS HAS CAMPER BEEN ILL?

WHAT TYPE OF SICKNESS?

MEDICAL HISTORY

DIABETIC

TAKE THYROID MEDS

EPILEPSY

HEART DISEASE

TAKE INSULIN

TAKE ASTHMA MEDS

CANNOT RUN

CANNOT GO IN THE WATER

ALLERGIC TO DAIRY

ALLERGIC TO EGGS

ALLERGIC TO WHEAT

ALLERGIC TO CHOCOLATE

ALLERGIC TO TETANUS

ALLERGIC TO PENICILLIN

ALLERGIC TO OTHER

ALLERGIC TO PEANUTS

PLEASE SPECIFY OTHER ALLERGY

EXPLAIN ANY SPECIAL HEALTH INSTRUCTIONS HERE

MEDICAL INSURANCE CARRIER

GROUP CERT. OR MEDICAL ID

DOCTOR'S NAME

DOCTOR'S PHONE

Parent/ Guardian (s) Name

Parent's email

I AFFIRM THE ABOVE INFORMATION TO BE TRUE, AND STATED CAMPER MAY PARTICIPATE IN ALL CAMP ACTIVITIES UNLESS OTHERWISE INDICATED.*

YES

Parent's Signature*

By signing below you are agreeing to the Camp Guidelines, you acknowledge that both yourself (as the authorized registrant) and the participant (camper), which maybe the same person, agree that the camper will follow the CAMP WEST guidelines specified in the Camp West Guidelines Document found on the website.

I, the undersigned, agree to the terms above.

Running Total

$0.00

Coupon Code

Total

$0.00

TIME UNTIL EARLY REGISTRATION ENDS:

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TIME UNTIL CAMP WEST BEGINS:

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Billing Information

Name*

I am representing an organization

Credit Card*

Visa
Mastercard
American Express
Discover

Address*

Email*

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