Register For Camp (Required fields are marked with *) register form Select a Camp*(Required)Senior Camp – Grades 10-12Intermediate Camp – Grades 7-9Junior Camp – Grades 4-6First Chance Camp – Grades 1-3Ourdoor Skill Camp – Grades 7-12Family CampCamper Information(Or enter primary contact person for Family Camp Registration)Name*(Required) First Last Entering Grade1st2nd3rd4th5th6th7th8th9th10th11th12thFamilyAge5678910111213141516171819FamilyGenderMaleFemaleCity(Required)State(Required)AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonZip/Postal Code*(Required)Camper Phone*(Required)Camper Email(Required) Home ChurchMember?Pick One:YesNoNot SureParent/Legal Guardian Information(required for campers under 18)Name(Required) First Last Address 1*(Required)Address 2City(Required)State(Required)AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonZip/Postal Code*(Required)Primary Contact Number*(Required)Secondary Contact NumberEmail FOR FAMILY CAMP ONLYNumber in your group (probable)0123456789101112131415 or moreLimited cabin space is available on a first-come, first-serve basis. Will you need housing accommodations? (Select one) Will need housing Will bring tent or RV How many tents will you bring?N/A0123 or moreHow many campers/RV’s?N/A0123 or moreMEDICAL RELEASEPlease indicate if the camper has a medical history in any of the following conditions (for 18 and over, please fill out for self – Do not fill out if registering for family camp):medical release Drug Allergies Food Allergies Insect bites or stings Heart disease/condition Asthma Seizure disorder Diabetes Behavior Disorder Physical handicap Stomach problems Other (specify below) UntitledPlease give details for any checked above. Include normal treatment of allergic reactions.Please list all medications the camper will be bringing to camp, along with dosages and frequency of use. This includes over-the-counter medications of any kind as well as asthma inhalers.Please list any activity-related restrictions that apply to the camper.Please list your insurance provider and policy number. If you prefer, leave this field blank and enter the information on the parental consent form instead.Date of last tetanus shot, if known (MM/DD/YYYY) MM slash DD slash YYYY Please enter any additional information that we should know in order to make your camper’s experience as safe and positive as it can be.In the event I cannot be reached in an emergency during my child’s attendance at camp, I hereby give my permission to the physician or dentist selected by Kootenai Christian Camp to do what he/she deems to be best and absolutely necessary for my child until such time as I can be reached. I will download, print, fill out, and submit a signed release form along with payment for camp. Yes No DOWNLOAD PDF FORMA link will also be provided on the registration confirmation page.Emergency Contact Number (required for youth camps)Please verify that an actual person filled out this form by clicking the checkbox below. When the green checkmark appears, click on the “Submit” button.CAPTCHA
