Break Forth Bible Church - Camp26 Registration

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:

Does the student use contact lenses?

List any activity restrictions:

Do you have health insurance?

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

Policy #

Group #

HEALTH WAIVER: As the parent [or legal guardian] of the above listed child, I attest that the preceding health history is correct and the juvenile listed above has my permission to attend Break Forth Bible Church, Inc. Youth Camp and to engage in all activities, except as noted. I, the undersigned, request that said juvenile be taken to the camp nurse and/or doctor if the need for medical treatment arises. I hereby give permission to the camp staff to dispense any over the counter medications and to secure proper treatment for said juvenile. I also give permission to the physician selected by the Camp Directors to, including but not limited to, hospitalize; secure proper treatment for; and to order injections, anesthesia, or surgery for my son/daughter, as named above. I understand that I will be responsible for any medical expenses incurred by said juvenile not covered by my insurance. I release my child’s medical records to Break Forth Bible Church, Inc. and understand that it will not be made available to anyone other than camp personnel and selected physician if medical treatment is required.

Alternate Emergency Contact

First Name

Last Name

Phone Number

BFBC TRANSPORTATION: I understand that transportation may be provided by Break Forth Bible Church [BFBC] to and from Abba's Haven and agree that my child will be able and willing to participate in such transportation. I consent for my child 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.

SPECIAL NOTE TO PARENT/GUARDIAN: All campers are required to stay throughout the entire event, participate in all scheduled activities, be respectful of staff/property, and follow camp guidelines. If a camper refuses to respond to staff and needs to leave camp, travel home will be the responsibility of the parent/guardian.

Signature

2026 BFBC Youth Camp Application

Jr. High Camp June 24-27
Sr. High Camp June 28-July 1

Health Information

Alternate Emergency Contact

2026 BFBC Youth Camp Application

Jr. High Camp June 24-27Sr. High Camp June 28-July 1

Health Information

Alternate Emergency Contact

Jr. High Camp June 24-27
Sr. High Camp June 28-July 1