New Camper Registration 2022

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Camper Information		Parent/Guardian Information		Authorizations

Camp Dates 2022

High School (Grade 9-12)	June 27 thru July 1
First Chance Camp (Grade K-1)	July 7 thru 8
Elementary Week 1 (Grade 2-5) (FULL CAPACITY)	July 11 thru 14 (FULL CAPACITY)
Junior High (Grade 6-8)	July 18 thru 22
Elementary Week 2 (Grade 2-5)	July 25 thru 28

Camper Information
Email address of person completing registration *
N/A

This will be the address tho which registration-related communications will be sent.
Camp Session *
N/A
Camper Name
N/A

Required First Middle Required Last
Birthdate *
N/A

MM-dd-yyyy
Today's Date
N/A

MM-dd-yyyy
Age
N/A
Grade Entering *
N/A

What grade will he/she be entering in the fall of 2022?
HS Graduation Year
N/A

What year will he/she or did he/she graduate from high school?
Gender *
N/A

Male
Female
Address
N/A

Required Street Address Address Line 2 Required City Required State/Region/Province Required Postal / Zip Code

Country
Camper Phone
N/A

Enter phone number for camper. If camper does not have his/her own number, please leave blank and enter parent/guardian number in the appropriate field below.
Camper Email
N/A

Enter email address for camper. If camper does not have his/her own email, please leave this blank and enter parent/guardian email in the appropriate place below.
T-Shirt Size *
N/A

(Child) Medium
(Child) Large
(Adult) Small
(Adult) Medium
(Adult) Large
(Adult) X-Large
(Adult) XX-Large
Church Information
Church Name
N/A
Pastor's Name
N/A

First Last

Parent/Guardian 1
Guardian 1 Name
N/A

Required First Required Last
Guardian 1 Relationship
N/A
Guardian 1 Phone
N/A
Guardian 1 Email Address
N/A
Is there a second parent/guardian?
N/A

Yes
No
Parent/Guardian 2
Guardian 2 Name
N/A

First Last
Guardian 2 Relationship
N/A
Guardian 2 Phone
N/A
Guardian 2 Email
N/A
Custodial Issues *
N/A

Yes
No

Are there any custodial issues that we need to be aware of concerning this child?
Custodial Issues
N/A
Emergency Contact

In the event of an emergency, if we are unable to reach one of the parents/guardians identified above, whom should we contact?
Emergency Contact
N/A

Required First Required Last
Relationship to Camper
N/A
Phone *
N/A

People Authorized to Pick Up Child from Camp:
-- No Fields Available --
- Name
- Relationship
Add Person Add Person
- Name
  N/A
  
  First Last
- Relationship
  N/A
- Name
  N/A
  
  First Last
- Relationship
  N/A
Please provide the names of any people (other than the parents or guardians) who are authorized to pickup your child from camp.
Please indicate how your camper will be departing from camp on the last day.
N/A

Pick up by an above listed person
Driving him/her self
Riding with another camper
Name of other camper
N/A

First Last
Permission to photograph
N/A

I authorize the taking of photographs and videos of my child. I understand that these maybe used within appropriate settings outside of Camp Union, provided that in such case, my child will not be identified by first and last name.

I agree.
Permission to transport
N/A

I give my permission for my child to travel off of camp property with authorized staff for camp activities.

I agree.
N/A

Informed Consent and Acknowledgement

Indemnification
I hereby give my approval for my child’s participation in any and all activities prepared by Camp Union during the selected camp. In exchange for the acceptance of said child’s candidacy by Camp Union, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Camp Union and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against Camp Union including all directors and affiliates, all participants, and, if applicable, owners and lessors of premises used to conduct the event.

Conduct and behavior
I understand that my child may be sent home due to inappropriate behavior or actions, as determined by the camp board and/or youth directors.

Medical Form required
I understand that in order to participate in camp activities, a completed medical form must be on file. This form will be emailed to me once I submit this registration, and I acknowledge that if I fail to bring the provided form, my child will not be permitted to participate at camp.

My signature here acknowledges that I have read, understand, and consent to the above conditions and that all information is as complete and as accurate as possible, to the best of my knowledge.
Signature
N/A

E-Signature Field
Clear
Payment
Payment Method *
N/A

Credit Card
Cash/check onsite
Mail check

How would you like to pay for your registration?
Registration Amount
N/A
$
Please make checks payable to Camp Union and bring to camp with you or mail to PO Box 86 West Mansfield, OH 43358 prior to camp.
Credit Card *

PaypalCheckout USD

Amount to be paid $

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New Camper Registration 2022

Camper Information

Church Information

Parent/Guardian 1

Parent/Guardian 2

Emergency Contact

Payment

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Form Summary

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