Camper Registration Form

Camper Registration Form
Camper Registrations Due by June 1st
After June 1st there will be a $20.00 late fee Dependent on Availability

Please let us know prior to registration deadline if special arrangements are needed.
We will do our best to accommodate your situation. We look forward to seeing you at camp!

If you have any questions, please contact us.

Camp Directors
Christine Madsen Shaun McIntire
(801) 363-8877 (801) 243-7071
campfellowship@mail.com

Please fill out all the information below to register your camper. Please DO NOT use a mobile device (phone or iPad) to fill this out, use a computer.

Camper Information

* Indicates required field

Camper's Name *

First

Last

Camper's School Attending *

Grade (Fall 2019) Grades 4th - 9th are eligible *

Parents / Guardians

Parent Name *

First

Last

Phone Number *

Best way to reach you DURING camp? *

Email *

Alt. Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Emergency Contact (other than you)

Emergency Contact Name *

First

Last

E.C Relationship to Camper *

E.C. Phone # *

Drop Off / Pickup

Name of Adult Dropping Child Off *

First

Last

Adult's Relationship to Camper *

Drop Off Phone # *

Name of Adult Picking Child Up *

First

Last

Adult's Relationship to Camper *

Pick Up Phone # *

Medical

Complete and SUBMIT the following form in its entirety.
Please feel free to contact our medical staff at any time to discuss these and any other concerns. Thank You!
Diane Forster-Burke RN
Phone: (801) 832-2163
email: cburke_5@msn.com

Please call or email if you have any questions regarding this section

Give dates of last incident of any conditions below, if applicable. If not, leave blank.

Asthma *

Heart Trouble *

Stomach upsets *

Seizures/Convulsions *

Sleep walking *

Diabetes *

Bed wetting *

Allergic reactions *

Headaches *

Nose bleeds *

Dietary concerns/restrictions *

Any behavioral concerns? *

Immunizations

*Date Required

Date of last Tdap (MM/DD/YYYY) *

*Date Required

Date of last MMR (MM/DD/YYYY) *

Pediatrician Name *

Pediatrician Phone *

Medications your camper is taking. Be as specific as possible. *

By checking this box, you are confirming that the medical information above is accurate and does not omit any critical health information. *

I agree

Any medication, including over the counter, must be in a properly labeled prescription container and must be turned into the camp nurse at registration.

* IMPORTANT *
In case of a medical emergency, I understand every effort will be made to contact the camper’s parent or guardian and physician. In the event they can not be reached, I hereby give my permission to the physician or medical facility selected by the camp staff to hospitalize, treat, and order medication or surgery, as needed, for my child named above.

If you would like to bring a copy of your child's insurance information to camp, you may.

As per EMS protocol, all children 17 & under will be taken to the nearest appropriate facility.

Zero Tolerance & Signature

ZERO TOLERANCE POLICY
Parents, it is very important to us that you take the time to discuss the following with your child/children.

Camp Fellowship has a Zero Tolerance Policy for drugs, alcohol, tobacco and weapons. Any camper who is found to have brought any items to Camp Fellowship that are banned or illegal, or is found participating in any illegal activity while at Camp Fellowship, will be required to leave camp.

Bullying, sexual harassment and inappropriate language will not tolerated.

In the event that a problem of this nature occurs, we will call you, the parent/guardian, and ask you to promptly pick your camper up from camp. Please take this opportunity to seriously discuss these issues with your camper/s to insure an exceptional camp experience for all involved.

Please be advised that campers who bring something from the "What NOT to bring" list will have item/s held in safekeeping until the end of camp. This helps us provide the optimal camping experience for your camper/s.

Please sign below that you have read, understand and discussed the above information with your camper/s. Thank you for helping us to make Camp Fellowship a safe and enjoyable place for Campers and Staff alike.

My camper and I have read, understand, and agree to the policies above and that the information we provided is accurate. *

We agree

Sign below

Parent Signature *

Camper Signature *

Additional Comments *

Date (MM/DD/YYYY) *

Submit

If you see a 'Please correct the highlighted fields' message after pressing the 'Submit' button, look for red rings around the field(s) to see which field(s) are missing data. Also remember to check the (2) agree boxes.