Renew Summer Camp Registration Form


*PLEASE READ FIRST: All campers should plan to pre-register either on-line here or through the mail (via this form maiiled to the address below) BEFORE CAMP BEGINS if at all possible.  RENEW COMMUNITY CHURCH | 1122 SOUTH 2ND STREET, CABOT AR 72023 | WWW.RENEWCABOT.ORG

Grade Level of Student *
Today's Date*
Camper's Full Name *
First Name
Last Name
Camper's D.O.B.*
Camper's Age*
Camper's Grade Entering*
Gender *
T-Shirt Size*
Full Address *
Address Line 1
Address Line 2
Postal Code
Parent/Guardian Name *
First Name
Last Name
Address (if different from above)
Address Line 1
Address Line 2
Postal Code
Student Cell #
Home Phone #
Parent/Guardian Phone #*
Additional Emergency Contact: Name & Phone # *
Email Address*
Who referred you to camp (if anyone?)
Health AND Insurance Information for Camper:
Family Physician: Name & Phone #*
Name of Health Insurance
Policy/ Group #
Insurance Contact # & Address
Please Select Any That Apply:
For areas checked above, please explain details here:
List camper’s allergies (food, medication, environmental, etc) along with reaction:
Does camper have any activity limitations? *
If Yes, Please Explain Limitations:
List of current medications for camper (PLEASE NOTE: All medications must be sent with camper in original labeled container and will be dispensed by Camp Nurse. ):
Occasionally, a camper may need an over‐the‐counter medication for simple health problem that may arise at camp.
Please check which of the following medications you WILL ALLOW your child to take at camp if needed:
My child needs transportation to/from Camp*
Please choose if camper need transportation TO camp, FROM camp or BOTH
Please explain why your child needs to utilize the Bus for Camp:
I hereby release Renew & it's Assignees from any and all liability associated with the ministry of transportation.
Agreement to Participate & Release Regarding Swimming, Pool or Open Water Activities. MANDATORY for 3rd - 6th Grade Campers.
I am aware participating in swimming, pool or open water activities ("this activity") can be dangerous and involves MANY RISKS OF INJURY. I understand that the dangers of participating in this activity include drowning and that the use of life jackets may reduce the risk of drowning. I understand that the dangers of participating in this activity may result in not only serious injury or death but also in serious impairment of future abilities to earn a living; engage in other business, social and recreational activities; and to generally enjoy life. Because of the dangers of participation in this activity, I recognize the importance of following the rules and regulations established by Renew Community Church and/or church and camp officials. I agree that my child will obey such instructions. I acknowledge that my child is in good physical condition and I do not know of any reason that my child cannot participate in this activity. I agree to inform Renew Community Church if my child's physical condition changes. I recognize and acknowledge that Renew Community Church does NOT carry special health insurance that would provide such special insurance coverage for my child in the event my child should sustain an injury while participating in this activity. I understand the risks involved in this activity and I voluntarily consent to my child's participation. By my signature below I hereby recognize and assume all risks associated with participating in this activity and agree to hold Renew Community Church along with its employees, agents, representatives, vendors and volunteers harmless from all obligations, liabilities, claims, demands, costs, and expenses including attorney's fees or demands of any kind and nature whatsoever that may arise from my child's participation in any activity related to swimming, pool or open water activities. These terms serve forever as a release and assumption of risk for my heirs, estate, executor, administrator, assignees, and for all members of my family. In signing this release, I acknowledge and represent that I have read it, understand it and sign it voluntarily as my own free act and deed. No oral representations, statements, or inducements apart from this Release have been made.
Life Jacket Requirement. Please select one. *
Parent/Guardian Signature For Water Activities Release:
Child's Name For Water Activities Release:
PLEASE READ AND SIGN: I hereby attest that I have read and reviewed this form and have completed it accurately and will report any information that may change. In the event of injury or illness, I hereby grant the camp, it’s staff, agents or representatives authority to furnish medical care and/or to choose any health care facility which it deems proper to provide emergency medical treatment. I also agree to pay for any necessary medical care for treatment of already existing conditions such as asthma, seizures, etc. I also agree that Bradley Christian Service Camp and its staff, agents, or representatives shall not be responsible for injuries or illnesses occurring while the above camper is on the campground, utilizing camp facilities and equipment, or under the control of camp staff at any time including injuries sustained while in transit to and from camp. I also hereby grant permission for Bradley Christian Service Camp to use camper’s photograph and/or video for the purpose of publications, promotions, or any other prudent use deemed necessary.
CANTEEN CARD: No cash should be kept in the camper’s possession during camp. Canteen money can be “checked in” when campers check in at the camp on Monday. This will reduce the fears of loss or theft. There will be opportunities throughout the week for your child to purchase items from the canteen. Campers will need approx $20 for the week. Your child’s canteen money sheet will be kept and tallied in the canteen during the week. WHAT TO BRING: A BIBLE, notebook, pen or pencil, Bedding for a twin bed (fitted sheet, top sheet, pillow with case, sleeping bag or blanket) Bug spray, sun screen, sunglasses, flashlight, towel for pool AND a separate towel for showers, bathroom essentials (toothbrush, paste, deodorant, soap, shampoo, etc.), multiple sets of undergarments, clothes and socks, MODEST clothing, 1 piece bathing suits (no bikinis), bathing suit cover, shower shoes (recommended), necessary medications (see medical form for details). WHAT NOT TO BRING: Outside snacks (we don’t need bugs and critters), weapons of any kind (including but not limited to pocket knives), tobacco products, drugs, or alcohol (immediate removal from camp will occur with weapons, drugs, alcohol, or tobacco). CELL PHONE POLICY: Cell phones may be brought; however, they should be powered off and only turned on when specific permission is given. Phones will be taken from campers and given back on the last day should they be in use when not authorized. No warnings will be given. BAPTISM POLICY: Should your child desire to be baptized while at camp, we will contact you first. *By signing below, you acknowledge that you have read, fully understand, and agree to abide by the things outlined here. This registration form does not include all of the rules of the camp; it is a highlight of the expectations. By signing below, you further agree to allow images and video be used for future marketing or publications for this campground. *Please attend all parent meetings. The first parent chat will be hosted February 25, 2017 at 10:30am. Please watch internet, Facebook groups, and bulletin/announcements for future dates of parent meetings.
Parent/Guardian Signature*
Camper Signature (7th - 12th)
Today's Date*