Morganwood Camper Registration Form

Camper Information

First Name * Middle Name Last Name * DOB * Sex * Select an option:MF Last Grade Completed * Select an option:_K4_K5010203040506070809101112 Address Line 1 * Address Line 2 City * State * Select an option:ALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY Zip * Email * Church Affiliation Church Pastor Youth Pastor T-Shirt Size * Select an option:YSYMS (Same as YL)ML1XL2XL3XL

Medical Information

Family Physician * Physician Phone *

Please bring or send a copy of your insurance card with the camper on the day of check in.

Insurance Provider * Insurance Policy Number * Allergy List * Who will be responsible for camper sunscreen? * Select an option:CamperStaff

Sunscreen Responsibility:
If (Camper) is chosen, the camper will keep their sunscreen and apply as needed.
If (Staff) is chosen, the camper's sunscreen will be locked in the first aid office and guided through application by the first aid staff per parental instruction as written on the medication dispensing form at check-in.

Emergency Contact Information

Name of Contact * Relationship to Camper * Select an option:MotherFatherStep-MotherStep-FatherSiblingGrandparentOther RelativeLegal GuardianFamily Friend Evening_Home Phone * Day_Work Phone * Mobile Phone *

Who Else Can Pick The Camper Up From Camp?

Names of people other than the Parent/Guardian listed on the Emergency Contact, Pastor, or youth pastor listed above who are authorized to pick up the child from camp. Please list at least one person. If more than three, please include in notes to staff.

Authorized Person 1 * Authorized Person 2 Authorized Person 3 Notes for the Staff

Are There any Siblings Attending the SAME WEEK of Camp?

Sibling 1 Name Sibling 2 Name Sibling 3 Name

Camp Rules Acknowledgment

I have read the camp rules at www.morganwoodcamp.org/camp-rules.
As I come to this Christian youth camp, I am willing to cooperate in the planned activities of the camp. I will be respectful to the staff. I agree abide by all camp rules and the dress code. It understand that if I become a discipline problem beyond the staff’s ability or desire to handle, my parent/guardian(s) or pastor will be called to
pick me up.

I Agree *

Parental Consent

I give my consent to a preliminary health assessment as required by the Mississippi State Department of Health. I also understand that in the event medical treatment is required for my child, every effort will be made to contact
me. However, if I cannot be reached, I grant permission to Morganwood staff to secure the services of a licensed physician of their choice to provide care necessary for my child’s well-being. I authorize all emergency medical and
surgical treatment, X-ray, laboratory, anesthesia, and other medical and/or hospital procedures as may be performed or prescribed by the attending physician and/or paramedics for my child and waive my right to informed consent of treatment in the event that I cannot be reached. I also give permission for my child to be transported off camp grounds for camp sponsored off-site activities. I also give permission for my child’s pictures or images to be included in publicity, publications, video promotions and the Morganwood website(s).

I Consent * Parent Name * Date of Consent *

Payment Info

Camp Dates:
Completed Grades 7-12 June 6-11, 2020
Completed Grades 4-6 June 13-18, 2020
Completed Grades 1-3 June 20-23, 2020
Completed Pre-K June 24, 2020

Camp Week * Select an option:Crusader_7th-12th ($90 USD)Horizon_4th-6th ($90 USD)Trailblazer_1st-3rd ($75 USD)Adventurer_Pre_K-K ($25 USD)

The First child from a household pays the full amount. There is a $5.00 discount for the second child from the same household and a $10.00 discount for each additional child from the same household.

Sibling Discounts NA2nd (-$5 USD)3rd+ (-$10 USD)

A snack shop is available for campers, allowing them the opportunity to purchase drinks, snacks, & souvenir items.
campers do not carry cash on their person during our camps in June, and cash is not accepted at the snack shop . A snack shop card is issued at check-in. Any money left on the card at the end of camp will be refunded at check-out. Those in Adventurer Camp do not need any funds for the snack shop.

Snack Shop 5 ($0 USD)10 ($5 USD)15 ($10 USD)20 ($15 USD)25 ($20 USD)30 ($25 USD)35 ($30 USD)

Insurance Card

Attach a Picture of Insurance Card