Soccer Camp Registration – New Life Bible Camp

What camp are you registering for?*

Camper Name*

First Last

Address*

Street Address City State / Province / Region ZIP / Postal Code

Church Affiliation*

Email

Gender*

Age*

Birth Date*

Grade Completed*

Parent/Guardian*

First Last

Home Phone*

Cell Phone

Emergency Contact Name (Not Parents)*

First Last

Emergency Contact Phone*

Is there one friend your camper would like to be in a cabin with?

We cannot guarantee your camper and their friend will be in the same cabin but we will take it into consideration when making cabin assignments.

Health Information

Please check physical difficulties/past illnesses

Diabetes
Allergies
Asthma
Seizures

Do you have any food allergies?*

If yes please explain:

yes
no

List Food Allergies

Other Health Information

Camper has special medication or health instructions explained below:

Family Physician*

First Last

Medical Facility*

Phone*

Medical Insurance Co.*

Policy Number*

Individual Camp Registration Fee*

Please fill out a separate form if you would like to register multiple campers.

Soccer Camp - $175.00 Per Person

Total

$0.00

PARENTAL ACKNOWLEDGEMENT*

I hereby acknowledge the following. 1. Affirm there is no need of a doctor's examination prior to camp based on good health history, or that such an examination has been obtained and is included with this registration. 2. Authorize New Life Bible Camp medical staff to dispense medications based on the above instructions. 3. Authorize qualified camp personnel to administer emergency medical care and determine the need for ambulance service or a physician's care. 4. Recognize the camp does not carry medical insurance and that I am required to pay for all medical treatment. 5. Recognize that the camp provides only secondary accident insurance for all campers and staff. 6. Allow my child to participate in all camp activities (which may be photographed) unless specific written instructions are included with is registration form. 7. Understand the camp reserves the right to dismiss any camper demonstrating behavior contrary to the best interest of NLBC. Transportation is immediate responsibility of the camper's parents.

First Last

Date*

Submit

Once you hit submit, your application will automatically be send to camp officials as well as the listed email address above. Payment process requires completing the paypal or credit card information.