Camper Information
* Child Gender Select one Male Female
* Child T-shirt Size Select one Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Adult XXL
* Child Grade Completed this Summer Select one 1st 2nd 3rd 4th 5th 6th
* Child Family Role Select a family role Adult College Age Student Child Other
* Child Local Church Select one Antwerp Community Bellefontaine Bethel Community Bowling Green Bradford Bryan Celina Countryside Cridersville Defiance Fayette Findlay First Fort Recovery Good Shepherd Greenville Hope Community Indian Lake Northside Kennard Kenton Leipsic Lima Community Lima First London Marysville Montpelier Mount Blanchard Mount Sterling Movement Church Napoleon New Carlisle Paulding Payne Pioneer Piqua Quest Indian Lake Quest West Liberty Sidney First Spencerville Springfield First Springfield High Street Springfield Maplewood St. Marys First St. Paris Community Swanton The Valley Church Tipp City Co Mission Toledo Toledo Northpoint Toledo Trinity Troy First Union City Urbana Wapakoneta Wauseon Community Wayne-Goshen Community West Milton Other
* Child Camper has read and agrees with the camp rules. Select one Yes No
Parent Information - Information of parents/gaurdians
* Child Mobile Carrier Select a mobile carrier Unknown No Texting 3 Rivers Tel. Coop., Inc. Alaska Communication Systems American Messaging Appalachian Wireless Arch Wireless AT&T Bell Mobility Canada Bellsouth Mobility Bluegrass Cellular Boost C Spire Wireless Carolina West Wireless CBeyond Cellcom Cellular Network Partnership Cellular One (Illinois) Cellular One of NE Arizona Cellular South Centennial Wireless Chariton Valley Cellular (Bellcore Assigned) Chat Mobility Cincinnati Bell Claro - Puerto Rico Comcast (Xfinity) Mobile Commnet Wireless Consumer Cellular (AT&T) Consumer Cellular (T-Mobile) Copper Valley Cellular Cricket Docomo Pacific (Guam Wireless) Eos Mobile Family Mobile Fido Flat Wireless (ClearTalk) Freedom Mobile GCI GCI Communication Corp. Gold Star Communications, LLC Google Fi H2O Wireless Illinois Valley Cellular Inland Cellular Iowa Wireless Services Jasper/Cricket Keystone Wireless Kitty Wireless Koodo Mobile Leaco Rural Telephone Cooperat Metro PCS Mid-Tex Cellular, Ltd. Mobile Nation MTN MTS Communications N-Telos Nex-Tech Wireless Nextel Non-wireless Phone NW Missouri Cellular O2 (UK) Optus Mobile Orange (UK) Page Plus Pine Telephone Pioneer Cellular Plateau Wireless PR Wireless (Open Mobile) Public Mobile Pure Talk Qwest Republic Wireless Republic Wireless/Bandwidth.com (Sybase) Rogers Safelink Sagebrush Cellular (Nemont) SaskTel Simple Mobile Smart Telecom Solo Southern Communications Services, Inc. Spectrum Mobile Sprint Straight Talk Suncom T-Mobile T-Mobile (UK) Telrite Wireless Telus Mobility Thumb Cellular Ting Total Wireless Tracfone UBET Wireless Unicel Union Wireless United Wireless Communications US Cellular Verizon Viaero Wireless Virgin Mobile Virgin Mobile (Canada) Virgin Mobile (UK) Vodacom Vodafone (UK) West Central Wireless Wind Mobile z-AT&T (alt) z-At&t (alt2) z-Sprint (alt)
* Child Emergency Contact (Name & Phone#)
* Child Pick-up Person(s)
* Child Parent(s) has read and agrees with the camp rules. Select one Yes No
* Child Payment Options Select one I will pay online I will mail a check to the director My church will mail a check to the director
Medical Information - Parent/ Guardian Waiver/ Permission Form and Medical and Civil Liability Release Form. If no insurance, please write N/A (Not applicable) in the appropriate fields.
* Child I have read the medical release on the website. Select one Yes No
* Child Medical Insurance Select one Yes No
Child Allergies to Medication
Child Medical Condition(s)Asthma Diabetes Seizures Sleep Walking Bed Wetting
Child Infections/ DiseaseSelect one Yes No
Child Restricted Activity
* Child Medications Select one Yes No
Child Special Instructions
* Child Guardian understands that my child will be transported off-site for certain events by church vehicles driven by counselors. Select one Yes
* Child Photo Release Select one Yes No