Camp Registration Please Read Choose Your Camp Children's - 3rd – 6th grade June 9-13 Youth - 6th – 12th grades June 2-6 Whoa 1 - Ages 9-12 June 15-18 Whoa 2 - Ages 13-18 June 18-21 Child * First Name Last Name Gender Male Female Date of Birth MM DD YYYY Age Grade Completed Student Cell Phone Number Student Email Address Parent/Guardian * First Name Last Name Phone (###) ### #### Email * Address Address 1 Address 2 City State/Province Zip/Postal Code Country Church Name Pastor's Name There will be photos and video taken at camp. Some of which will be used in future promotional ads, and or video. I understand the camps photo and video policy T-shirt Size Adult Small Adult Medium Adult Large Adult XL Adult XXL Adult XXXL Adult XXXXL Child Small (2-4) Child Medium (6-8) Child Large (10-12) Child XL (14-16) Do you give permission for your student to swim Yes No My child has permission to participate in a canoe trip one day. (6th-12th grade only)? Yes No I understand that my child will NOT be allowed to have their cell phone at camp I Agree As a camper I am expected to always listen and follow rules and instructions from Camp Director, Cabin Leaders, Bible Study Teachers Rotation Leaders, Riding Instructors (camp WHOA only), and Kitchen Staff . I Agree As a camper I am expected to treat staff and fellow campers with respect, which means having self-control and self-discipline. I Agree . As a camper I am expected to participate in each activity which includes Bible study, crafts, music, recreation, swimming, missions, and horses (camp WHOA only). If an illness or injury prevents me from participating, I must be in the company of the camp nurse. I Agree As a camper I am expected to participate in chores which include cleanup of dining hall after meals, maintaining a clean cabin, and cleaning the campground as needed. This also includes feeding and care of horses, (camp WHOA only). If an illness or injury prevents me from participating, I must be in the company of the camp nurse. I Agree CAMP WHOA ONLY Please Read Have you had riding lessons? Yes No If yes, for how long? Can your Child (Click all that apply) Saddle Bridle Clean hooves Walk Trot Canter (with good balance, soft hands) Whether it is the child’s horse or not does your child have a horse available to ride on a regular basis? Yes No RadioDoes your child show or compete with their own horse or on a horse in a riding facility? Yes No If yes, please give a brief description of show or competition your child participates in. If your child has attended Camp WHOA in the past, how many summer camps have they attended? If your child is attending camp with friends, please indicate who your child would like to have as a roommate in their cabin: HEALTH REGISTRATION Are you (camper) under the guardianship of the court, government agency or foster ? Yes No Please check if you have had a history of any of the following, (any medical history?) Asthma Heart trouble Sinus trouble Ear trouble Bed wetting Diabetes Frequent colds Allergies Athletes foot Upset stomach Kidney trouble Sleepwalking Epilepsy Emotional difficulty If Allergies are checked, please specify to what Please List Any Medications Authorization to use these over-the-counter meds: Ear Drops Eye Drops Ibuprofen Tylenol Antacid Dietary restrictions: Activities that should be restricted Family Doctor Name & Phone Number In case of Emergency, I understand that the people listed above will be notified if possible and I hereby give permission to the Physician selected by the Camp Director to hospitalize, secure proper treatment for, and to order injection, anesthesia, or surgery for my child (or myself) as named above. NOTE: Laclede Baptist Camp insurance is a secondary insurance. The camper’s insurance is primary insurance. Name of camper’s insurance Phone Number / Policy Number / Group Number Thank you!