Illinois Free Will Baptists
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Camper Application
Please read the
Camp Rules
before filling out this form.
Do Not Use this form for Leadership Camp
(A Separate Form is Available)
T-Shirt Section
(below)
must be filled out to receive free shirt
Check Week of Camp you Will Attend
(Grades Refer to the
Next
School Year)
To register for Camp please complete the form below for EACH camper OR
click here to download an Application Form
.
*
Indicates required field
Week of Camp
*
3rd/4th Grade Camp (June 26-30)
5th/6th Grade Camp (July 3-8)
7th/8th Grade Camp (June 12-17)
9th/10th Grade Camp (June 19-24)
11th/12th Grade Camp (June 5-10)
Note - Campers may only attend 1 week of camp with their age group.
Name of Camper
*
First
Last
Church
*
Pastor
*
Camper's Home Address
*
Line 1
Line 2
City
State
Zip Code
Country
Campers Email
*
School Grade (Entering this fall)
*
Are you a first time camper?
*
Yes
No
Do you want an 8X10 group photo of your week of camp for $5.00?
*
Yes
No
Are you using the Family Plan?
*
Yes
No
Families with 3 or more children attending camp will pay a maximum of $225 per family if ALL campers are pre-registered
If yes, list other family members attending camp
*
PARENT (or Guardian): Do you give permission for your child to be treated for injuries?
*
Yes
No
NOTE: We hope to provide a safe camping experience for your child. Should an illness or injury occur, every effort will be made to contact you, but we need your permission to treat medical emergencies
EMERGENCY PHONE NUMBERS (Home)
*
(Work)
*
Cell
*
CAMPER: Do you agree to abide by the rules & dress code and to cooperate fully with camp personnel?
*
Yes
No
Click here to review the Camp Rules and Dress Code
Church Address
*
Line 1
Line 2
City
State
Zip Code
Country
MEDICAL INFORMATION
Does the camper have any health problems that require medicines or a special diet?
*
Yes
No
MEDICAL INFORMATION
*
Please list any health problems that require medicines or a special diet for our nurse.
Any Known Allergies?
*
None
Bee Stings
Wasp/Hornets
Insect Bites
Other
Other Allergies
*
Will you be taking medication during your camp stay?
*
Yes
No
Please list any medications that you will be bringing to camp. (Medications must be in prescription bottles)
*
Family Physician's Name
*
Doctor's Phone Number
*
Other Special Instructions
*
T-Shirt Order Form
- One Free T-Shirt Per Paid Camper
T-Shirts can be picked up during the week of camp after successful registration and payment of fees
Additional T-Shirts can be purchased for $8.00 each
Please Choose only ONE Here
YOUTH Size Shirt
*
Small (6-8)
Medium (10-12)
Large (14-16)
None
ADULT Size Shirt
*
Small (34-36)
Medium (38-40)
Large (42-44)
X-Large (46-48)
XX-Large ($2 extra)
None
Additional Shirts
*
Additional T-Shirts can be purchased for $8.00 each. Please make a note here of the additional shirts you wish to purchase.
Submit
