2025 BFBC Camp
Leader Application

Jr. High Camp June 18-21
Sr. High Camp June 22-25

First Name

Last Name

Applying for:

Date of Birth

Gender

Female

Male

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Cell Phone Number

Marital Status

Home Church

Health Information

No medication of any sort [not even aspirin] is to be brought to camp unless it is prescribed by a doctor. All doctor prescribed medication is to be submitted to camp staff immediately upon arrival.

Please list any pre-existing medical conditions (including emotional/behavioral)

Name, dosage & time of any medications to be taken:

Please list ALL allergies, including medications and/or insect stings:

Height

Weight

Date of last tetanus shot:

Contact Lenses?

List any activity restrictions:

Do you have health insurance?

If Yes, please give the name of the health insurance company:

Policy #

Alternate Emergency Contact

First Name

Last Name

Phone Number

If you will be using BFBC transportation to and/or from camp:

I understand that transportation may be provided by Break Forth Bible Church [BFBC] to and from Abba's Haven and agree that I will be able and willing to participate in such transportation. I consent to participate in said transportation and agree to release and hold harmless BFBC from any and all liability. BFBC reserves the right to make changes in the itinerary where deemed necessary. Baggage and personal belongings are at the owner's risk entirely.

I Agree

I give my permission for Break Forth Bible Church to run a national background check.

Signature

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2025 BFBC CampLeader Application

Jr. High Camp June 18-21Sr. High Camp June 22-25

Health Information

Alternate Emergency Contact

If you will be using BFBC transportation to and/or from camp:

2025 BFBC Camp
Leader Application

Jr. High Camp June 18-21
Sr. High Camp June 22-25