Central Baptist Church | Trussville, AL

YM360 YOUTH CAMP

Camp registration form and waivers

Camper Information

First Name

Last Name

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Phone Number

Email

Birthdate

Grade

Allergies

Medications needed

No

Yes

List Medications and Dose

Medical Insurance Information

Parent Information

First Name

Last Name

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Email

Phone Number

Emergency Contact Information

In the event we cannot reach you.

First Name

Last Name

Phone Number

Relationship to camper

Waivers and Permissions

Medical and Media release

Medical

I give permission for CBC to get my child(ren) medical assistance if it is needed at any facility (ER or Urgent Care)

Multiple Choice

Yes

No

Media

I give permission for the representatives of CBC to photograph and or video my child(ren) during this event. Photos or videos may be used on social media and the church website.

Multiple Choice

Yes

No

Parental Consent

I give CBC and representatives of CBC permission to take my child(ren) on the Youth Summer Camp trip to Covenant College.

Signature

Registrations

YM360 YOUTH CAMP

Camp registration form and waivers

Camper Information

Parent Information

Emergency Contact Information

In the event we cannot reach you.

Waivers and Permissions

Medical and Media release

Medical

Media

Parental Consent

Service Times

Contact Info

Follow Us