RM_StatsJunior Camp WHEN | June 17-21@ Palmer Christian Church, Palmer, AKAGE | Entering 3rd-5th GradeDEAN | Roy MeyerCOST | Early - $80, Late - $95 Early Registration Deadline: May 19th Camper Information First Name *Last Name *Gender * Male Female Grade (going into) *Select an option3rd Grade4th Grade5th GradeAge *Birth Date *Name of Church *Select an optionChristian Church of AnchorageCook Inlet Christian Church - AnchorageCommunity Christian Church - Eagle RiverFarewell Ave. Christian Church - FairbanksFilipino Bible Church - KodiakHomer Christian ChurchHope Christian ChurchKenai Christian ChurchPalmer Christian ChurchOtherWhich church?Has the camper attended a Greatland Christian Camp previously? * Yes No Has the camper made a public decision to follow Christ and been baptized by immersion? * Yes No Medical & Emergency Information Medical Insurance Provider *Insurance Policy # *Does the camper have any allergies or physical/medical conditions that the camp should know about? * Yes No Allergies/Medical ConcernsPlease list all physical/medical conditions and allergies that the camp should know about.Will the camper need to take any prescription medications during camp? * Yes No Prescription MedicationsPlease list all prescription medications the camp will need for the camper. (The Camp Nurse will be keeping all medications.)May the camp nurse provide Tylenol or equivalent if needed? * Yes No Emergency Contact (other than parent/guardian) *Relationship to Camper *Phone Number *Parent/Guardian Information Parent/Guardian Name *Second Parent's NameMailing Address Address Line 1 * Address Line 2 City * State or Region * Zip * Phone Number *Email *Agreements PARENT RELEASE *As parent or legal guardian of the camper named on this form, I grant my permission for said camper to participate fully in the activities of the camp program. I also grant the Camp staff my permission to secure any and all emergency medical attention they deem necessary for said camper until I can be reached. I also agree to hold harmless the sponsoring churches, their leaders, and the camp staff for any accidental injuries, illnesses, theft, or other loss or damage of personal property.I have read and agree to the above conditions.CAMP GUIDELINES * I have read and agree to the camp guidelines linked below. >> LINK TO CAMP GUIDELINES <<May we use photos of your child at camp to promote Greatland Christian Camp? * Yes No Fees & Payment Registration Fee *Additional Fees * Special Menu - Food Allergies ($ 10.00) * If your child has food allergies that must be accommodated with a special menu please select this additional fee. Select a payment method * Pay Offline Note: It looks like JavaScript is disabled in your browser. Some elements of this form may require JavaScript to work properly. If you have trouble submitting the form, try enabling JavaScript momentarily and resubmit. JavaScript settings are usually found in Browser Settings or Browser Developer menu.