Youth Retreat Online Registration Form

Youth Retreat Registration

Online Registration

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Please submit one registration form per camper per session. Do not combine campers or sessions on one form.

Note: Medical information is together with the registration on one form.

Name:

Address:

City:

State:

Zip code:

Phone: (parent’s home)

Parent’s work:

Age:

Sex:

Male

Female

Grade during 2022-2023

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DISCIPLINE

DISCIPLINE

Discipline is necessary and each camper is expected to help in maintaining discipline through cooperation with all staff personnel. Without good discipline the camp cannot discharge its primary function of guiding the Christian development of each camper. Any one who behaves in a way that is not conducive to the good of the camp will be asked to go home! Christ is the Lord and Savior, and we want to glorify Him and edify each other. Please read all the rules stated in the Camp Brochure. Everyone is expected to obey them. We believe these rules will help our camp reflect the image of Christ.

“I have read the rules and agree to abide by them.” Signed:

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CAMPER MEDICAL INFORMATION

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Please provide the following medical information. If additional information would be helpful, write this information on a separate sheet of paper and attach it to this form.

ALL MEDICATIONS WILL BE KEPT BY THE CAMP STAFF!

Describe any health reasons for limiting the child’s camp activities:

Describe any allergies your child might have (include medication):

Does your child take any prescription medication?

Yes

If yes, please list:

Can the child administer his or her own medication?

Yes

If necessary, do we have your permission to administer Tylenol?

Yes

Other

Date of your child’s last Tetanus vaccination?

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IN CASE OF EMERGENCY, WHO SHOULD WE CONTACT?

1st Emergency Contact Name:

Phone:

Contact 1 Address:

2nd Emergency Contact Name:

Phone:

Contact 2 Address:

DOCTOR INFORMATION

Doctor Name:

Doctor Phone:

Doctor Address:

For your child to attend camp we must have a copy of your medical insurance card and the following information:

Insurance Company:

Insurance Address:

Insured Name:

Group Number:

Identification Number:

Prescription Card Number:

I give permission to Flint Hills Camp Staff to authorize medical assistance by a qualified person in case of a medical emergency and I cannot be reached. I understand that unless the situation is life-threatening and needs immediate intervention, there will be an effort to contact me before any medical decisions are made.

Signed:

Date:

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Camper Mail:

You may send letters to campers at:

Flint Hills Christian Camp

c/o General Delivery

Sedan, KS 67361

Youth Retreat Registration

Online Registration

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Camper Mail: