* Child Gender Female Male
* Local Church Select one Agape All Nations - Tout Nasyon Ancient Paths Bicknell Bloomington Eastview Bloomington First Boonville Brazil Brownstown Calvary Community Fellowship Cayuga Chandler Christ's Community Chuck Wagon Cowboy Clarksville Parkwood Cloverdale Columbus First Community of Hope Cory Community Crossroads Community Crothersville Dale Evansville Beacon Evansville Faith Evansville Grace Faith Community Family Fellowship Francisco Freedom Freetown Grandview Greencastle Haleysburg Harmony Chapel Heartland Jasper Jordan Kurtz Mackey Mitchell Nashville Parkview Newburgh Newburgh New Life Northside Community Oakland City Oasis of Hope Odon Orleans Owensville Patricksburg Peter's Switch Petersburg Point Township Princeton New Life Restoration Rockport Rockville Salem Shalom Hispanic Shoals Spencer First Springs Valley St. Bernice Stinesville Sullivan Tell City Terre Haute First Terre Haute Southside The Point (Seymour) Turning Point (Heltonville) Union Chapel Valley Mission Vincennes First Washington Wellspring Winslow Zion Community Other
* Camp - Grade completed Select one 1st 2nd 3rd 4th 5th 6th
* Child T-Shirt Size Select one Youth X-Small Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult X-Large Adult 2XL Adult 3XL
* Child Allergy/child notes
Medical/ Medicines Authorization - I hereby give permission for my child to receive over-the-counter medications indicated from parent via this online application or a note in person. Prescription medications provided by parent in original, labeled container as deemed necessary by the volunteer nursing staff. I understand that the volunteer nursing staff who administers the medications according to the proper dosages shall not be held liable for any adverse reactions to the medications administered.
* Medical Authorization Agreement Select one Agree Disagree
Restricted Activity - I give my permission for my child to engage in all learning and recreational activities at camp. I certify that my child is able to participate in those activities and that all medical conditions or allergies of my child may limit my child's participation in activities are indicated in medical conditions.
* Restricted Activity Agreement Select one Agree Disagree
Photo Release - Occasionally, campers are photographed or videotaped for use in communications and marketing materials. Your camper will likely be photographed while attending camp at Shiloh Park Retreat & Conference Center. If there is an issue with photo release, please email camp director.
* Photo Release Consent Select one Yes No
Discipline/ Damage Policy - I hereby state that I will abide by all camp regulations, respecting all leadership and policies of the camp. I also agree to waive any and all claims against the district, church, or any of the representatives, due to injury or damage that may be incurred to my property in connection with my stay at the camp. Recognizing that I am using the property of Shiloh Park Retreat & Conference Center, if I am found to be willfully damaging or destroying camp property, I will be held personally responsible for repair or replacement.
* Discipline and Damage Agreement Select one Agree Disagree
Medical Information - Please fill out all medical information completely.
