2024 Heartland Bible Methodist Youth Camp Camper Registration

Registration

Camper ($90.00)

Name

Phone Number

Gender

Male
Female

Address

Have you attended Heartland Bible Methodist Youth Camp in the past?

Do you have a room/cabin/RV spot you prefer to stay in?

Do you have preferred roommates?

Who is your Pastor and what church do you attend?

Is your father a Conference Elder currently pastoring a Conference Church?

Date of last Tetanus shot? Month and year is acceptable. If you do not know, enter "Unknown".

List any medications you will be taking during camp. All medications are to be turned in to the First Aid Team during registration. Enter "None" if you have no medications.

List any allergies to food or drugs. Enter "None" if you do not have any allergies.

Name of Health Insurance Company

Health Insurance Policy Number

Enter the name of the parent/guardian who will be signing below.

Enter the phone number for the parent/guardian who will be signing below.

Please read and sign the authorization for medical treatment.

Authorization to Consent to Transport & Treatment of Minor:
(I)(We), the undersigned, parent(s)/guardian(s) of the registrant , a minor, do hereby consent to any X-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care which is deemed advisable by, and is to be rendered under the general or specific supervision of any licensed physician and surgeon. It is understood that this authorization is given in advance of any specific diagnosis or hospital care being required, but it is given to provide authority and power on the part of the Heartland Bible Methodist Youth Camp’s staff to give specific consent to any and all such diagnosis, treatment or hospital care which the physician in the exercise of his/her best judgment may deem advisable. We also give permission for the nurse volunteers on the First Aid Team to dispense common Over the Counter medications as applicable, if requested by the camper (unless otherwise notified, in writing, by the parent/guardian).
The signature below must be by the parent/legal guardian unless the camper is 18 years old or above.

I, the undersigned, agree to the terms above.

Other emergency contact name and phone number

List any exceptions to the authorization above including any Over The Counter medications that may not be given to the camper. Please identify anything else that is a medical concern. if there are none, enter "None" in the box.

Rules and dress code

NOTE: The Camp President may go over additional rules at camp. Please read carefully with respect to dress code so the appropriate attire is brought to youth camp.

1. All campers are expected to participate with their team in every activity, camp work detail, and attend all worship services.
2. All campers are expected to cooperate with each team leader, assistant team leader, camp staff, and the Camp President.
3. Campers are not permitted to leave the campgrounds unless given permission by the Camp President.
4. All campers and staff are required to dress modestly at all times. Ladies, no pants or shorts are permitted. Your skirts and dresses must be below the knee while sitting. Gentlemen, wearing of shorts will not be allowed. Neither ladies or gentlemen will be allowed to have low cut shirts. All shirts must have sleeves and completely cover the torso. Wearing of jewelry will not be allowed by either camper or staff. Clothing should not be suggestive, or present dark and gross messages or images. All clothing should be worn carefully, appropriately, and nothing should be form fitting.

I, the undersigned, agree to the terms above.

Print name of person who signed above.

Please leave any comments that may help us with your preregistration.

Coupon Code

Total

$0.00

Convenience fee ONLY applied if paying by credit card.

$3.00