.
BOILING SPRINGS CHRISTIAN SERVICE CAMP
2019
2019 CAMPER REGISTRATION

First Name  Last Name

Address City , Zip

Home Telephone Sex Age Grade entering fall of 2019

Church Name

Have you been immersed for the forgiveness of your sins? (Acts 2:38) Yes No

Have you attended BSCSC before? Yes No Are you interested in attending Bible College? Yes No

“I agree to follow the rules of camp as stated on page two of this form and in the Camp Book.”

Sign with finger or mouse
(Signature of Camper)

Please check the camp that you will be attending. (Based on the grade you will enter in the fall of 2019)

Before 5/13..After 5/13

Grades 1-2;June 1........................$35..$40

Grades 10-12;June 2 - 7.....................$135.$150

Grades 3-4;June 9 - 11......................$75..$90

Grades 5-6;June 11 - 14.....................$100.$115

Grades 7-9;June 16 - 21.....................$125.$140

Circle Shirt Size

Adult



Youth



There is a $5 charge for 2X and 3X payable when ordered. Shirt orders after May 13 may not be filled.



REGISTRATION DEADLINE: 5pm May 13th, 2019

To pre-register, return this registration form and consent to your church sponsor, along with payment in full.


"I hereby give my permission for my camper to go swimming with the other campers."

Sign with finger or mouse
(Signature of Parent or Gaurdian)

“I hereby give my permission for BSCSC to record my likeness and/or voice to be used in printed and online promotions or advertising.”

Sign with finger or mouse
(Signature of Parent or Gaurdian)

I (we), the undersigned parent(s) or legal guardian of (print name), a minor, hereby authorize and consent to any first aid, medication, medical treatment or surgery for said minor, deemed necessary or advisable by any emergency unit, hospital, doctor, nurse, dentist, or other medical practitioner located in any state, country, or elsewhere. If possible, before treatment, I request a reasonable effort to contact me at the phone number(s) listed below. This consent shall be valid so long as said child is a minor and can be revoked only in writing and delivered personally or by certified mail to Boiling Springs Christian Service Camp, P.O. Box 884, Woodward, OK 73802. Any copy or facsimile of this consent shall be valid as an original.

Sign with finger or mouse
(Signature of Parent or Gaurdian)

Address of parent(s) or guardian(s)

Camper’s Date of Birth Date of last Tetanus Diphtheria Booster

Allergies to drugs, bugs, or foods

Any special medications or pertinent information

Telephone where parents may be reached in the event of an emergency


Name

Home

Business

Name

Home

Business

Family Physician Telephone

Insurance Company Policy #