CAMP COME ALIVE REGISTRATION

Name

Date of Birth

Gender

Grade for 24-25 Year

Student's Phone Number

T-Shirt Size

Parent/Guardian Name

Parent/Guardian Phone

Parent/Guardian Address

Parent/Guardian Email

This address will receive a confirmation email

Relationship to student

Emergency Contact

Contact #1 Name

Phone Number

Relationship to Student

Contact #2 Name

Phone Number

Relationship to Student

Church Information

Church Name

Church Address

Church Phone Number

Youth Leader that you're coming with

Youth Leader's Email

Dietary Needs

List Allergies or Special Dietary Needs

Liability Waiver

As the legal parent or guardian of the student listed on this form, I release and hold harmless The Global Methodist Church, the designated sponsors of the church camp as well as any others that volunteer or assist from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, or injury, including death, that may be sustained by the participant and/or the undersigned, while in or upon the premises or any premises under the control and supervision of the leaders, or en route to or from any of said premises.

I have read the above and agree.

Signature

Consent to Seek Medical Attention

The undersigned gives permission to Camp Horizon and the designated sponsors of the Global Methodist Church Camp as well as any others that volunteer or assist to seek medical treatment for the participant in the event they are not able to reach a parent or guardian. I hereby declare any physical/mental problems, restrictions, or conditions and/or declare the participant to be in good physical and mental health.

Signature

Physician's Name

Preferred Hospital

Known Medical Conditions

Allergies

Medications Currently Taking

Insurance Information

Insurance Provider

Policy Number

Card Holder's Name

Card Holder's Date of Birth

Picture of Insurance Card Front

Upload (8MB)

Picture of Insurance Card Back

Upload (8MB)

Payment

Deposit Amount 75.00

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

We are excited to welcome your middle/high school student to Camp Come Alive! This camp will take place at the beautiful Camp Horizon located just outside of Ark City, Kansas. Get ready for a week of fun, fellowship, and diving deeper into your relationship with Jesus! Camp check-in will be Monday, July 28th from 10-11:30 am, and check-out will be Friday, August 1st at 4 pm.
The cost to attend is $299. On this form, you will be required to pay a $75 deposit. The remainder of your fee is to be paid directly to your local church and then the church will make the final payments on your behalf.
For any questions email CampComeAlive@heartlandgmc.org

CAMP COME ALIVE REGISTRATION

Description

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