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Youth Camp Student Registrationopenbiblecentral2022-05-02T20:39:45+00:00

2022 Youth Camp Registration

Step 1 of 2

50%

This form is REGISTRATION OF STUDENTS only.

NO MONEY WILL BE COLLECTED. Finances should be turned in to the youth director of your local church.

Regular Registration Deadline: July 7, 2021 (Afterwards $30/student will be added)

Late Registration Deadline: July 14, 2021

How many students in your family are you registering?(Required)

Student Name ($249 Registration Cost)(Required)
Gender(Required)
Grade just completed(Required)
T-Shirt Size(Required)
Please list any and all medication.

Student 2

Student #2 Name ($229 Registration Cost)(Required)
Gender(Required)
Grade just completed(Required)
T-Shirt Size(Required)
Please list any and all medication.

Student 3

Student #3 Name ($209 Registration Cost)(Required)
Gender(Required)
Grade just completed(Required)
T-Shirt Size(Required)

Student 4

Student #4 Name ($209 Registration Cost)(Required)
Gender(Required)
Grade just completed(Required)
T-Shirt Size(Required)
Please list any and all medication.

Student 5

Student #5 Name ($209 Registration Cost)(Required)
Gender(Required)
Grade just completed(Required)
T-Shirt Size(Required)
Please list any and all medication.

Your Information

Your Name (Parent or Guardian)(Required)
Your Email(Required)
Family Address(Required)

Family Insurance Information

Permission and Release

PERMISSION TO PARTICIPATE: We (I) the parent(s) or legal guardian(s) of the student named on this form hereby grant our (my) permission for the student to participate fully in camp activities July 26-30, 2021.

MEDICAL TREATMENT PERMISSION: We (I) authorize an adult camp staff member, in whose care the minor has been entrusted, to consent to any emergency x-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment and hospital care to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital or emergency care facility. The undersigned shall be liable and agree(s) to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned student pursuant to this authorization.

PHOTO & VIDEO RELEASE: I understand and grant permission for the student's image and voice to be captured in photography, video or audio during camp, and that image shall be the property of Open Bible Central Region for promotional use.

Signature Authorization(Required)

Final Cost

This is for informational purposes only. Please turn in finances to your youth director. Price may increase or decrease based off of local church decisions for transportation as well as fundraising.

Title

Contact Us

1920 Bell Ave., Des Moines, IA 50315

info@openbiblecentral.org

515-282-6491

Insurance Partner

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