Camper Registration

Camp week *

Name *

First

Last

Gender *

Age *

Shirt Size *

Address *

Email *

Parent/Guardian Name

Emergency Contact Telephone *

Church Name *

Church Address

Medications taken regularly

Last Tetanus shot

Known Allergies *

Known reactions (if applicable)

Known Treatments (if applicable)

Activity Restrictions

Special requests *

I indemnify and save Camp Deer Lake and its affiliates, employees, and agents harmless from any liability or medical payments resulting from my child's participating in this camp or other activities during his/her stay at Camp Deer Lake. I further understand Camp Deer Lake does not provide medical insurance coverage for my child and that any medical expenses incurred will be paid by either my own medical insurance or myself. I hereby grant permission for my child to attend camp, to participate in all camp activities, and to be treated by a licensed medial professional in the event of any injury, accident, illness, or other situation that may require medical attention. I affirm that the medical information provided here is both complete and correct. I grant permission for my child's picture to be used in our promotional publications if selected. *

I understand and accept the terms stated throughout this application form.

Parent/Guardian Signature *

First

Last

Camper Registration

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Early Registration Discount

Combination Week 1

Combination Week 2