CAMP 412 Registration

I am a

Counselor

Camper

Other

First name

Last name

Gender

Birthday

Month

Day

Year

Address

Name of Parent or Guardian

Emergency Contact Name

Preferred Phone Number

Emergency Contact Phone Number

Pastor/Church Name

Name of Physician / Phone number

Medical Insurance Name and Policy #

Special Needs/Allergies/Chronic Diseases/etc..

Medications

Date of Last Tetanus Booster

Additional Notes/Concerns

I've read the consent form for Medical Treatment and Liability listed in the next section of this webpage, and I accept the terms stated.

If a counselor or adult volunteer, I understand a background check and Child safety training will need to be completed. (Link found below - MUST SUBMIT BOTH by June 30th, prior to coming to Camp412 / Child safety training must be completed (This will be sent to you after completing background check.)

https://ministryopportunities.org/opportunity/86561

Upload Medical Consent form with Date and Signature

Signature

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*Please note that the consent form for Medical Treatment and liability will need to be printed out if unable to be uploaded into the registration form above. Must be signed by a parent or legal guardian. The Form will need to be turned in to the camp leaders.*

Camp412 Medical Consent

MANDATORY BACKGROUND CHECK FOR VOLUNTEERS

You must include the fee in order to be successfully registered for Camp412.

The fees are as follows:

Campers - $100 Per person

Counselors - $50.00

The Fee can either be paid online or mailed to the following address: 1101 Obetz Rd, Columbus, Ohio 43207. If you would like to pay online, please click on the link below. Select "Other" in the comments please list the names of the camper and/or counselor.

PAY CAMP REGISTRATION FEES