Facebook  YouTube Contact Us

Registration: Teen Chill (Ages 13-18) (Feb 2, 2018 - Feb 4, 2018 AST)

Guest Bible Teacher: Mr. Tyler Horton

USER INFORMATION
Parent's / Guardian's or Adult Camper Information
Title:
Parent's/Guardian's/Adult's First Name:
Parent's/Guardian's/Adult's Last Name:
Primary Phone :
Secondary Phone :
Other Phone :
Email:
Confirm Email:
Address:
Address 2:
City:
Province::
Postal Code:
1
Camper's Information
Camper's First Name:
Camper's Last Name:
Camper's Sex:
Male  Female  
Camper's Age:
Camper's Birthday:
   
Camper's Medical Information
Provincial Medicare Number:
Province of Medical:
Medicare Expiry Date (MM/DD/YYYY):
Health Concerns:
Does the camper have allergies?:
Medications coming to camp with complete dosage and delivery instructions.:
Do you give Hampton Bible Camp permission to give over-the-counter medications to your child/adult camper (i.e.; Tylenol (acetaminophen), Benadryl (diphenhydramine), Pepto Bismol, or Tums (antacid)?:
Yes  
Yes - with a phone call  
No  
Request Cabin Mate:
Yes  No  
Camper Lives With:
Comments or special requests:
I, the PARENT/GUARDIAN, have read and agree to the Assumption of Risk Form:
Yes
I, the CAMPER, have read and agree to the Assumption of Risk Form:
Yes
I, the PARENT/GUARDIAN, have read and agree to the Parent Permission Form:
Yes
Enter the Security Code:

Sign up to get our newsletter!