Back 2 School Bash

2025 Back 2 School Bash Registration Form

Date: August 22-24

Cost per Camper: $80.

*Price is for online registration. For in person, cash registration it is $75 per person.

Camper Information

Camper's Full Name:

Gender:

Age:

Date of Birth:

Grade:

Name of requested cabin mate (not guaranteed):

Camper's Medical Insurance Company :

Medical Insurance Company's Phone # :

Past Medical Problems:

Current Medical Problems:

Medication Currently Taking:

Surgeries:

Allergies:

DPT Shot?

Last Tetanus Shot Date :

List Physical limitations we need to know about :

How will you get to camp?

If Other:

How will you get back home after camp??

If Other:

Parent/Guardian Information

Parent/Guardian 1 Full Name:

Parent/Guardian 1 Email:

Parent/Guardian 1 Phone:

Parent/Guardian 1 Address:

Parent/Guardian 1 City:

Parent/Guardian 1 State:

Parent/Guardian 1 Zip:

Parent/Guardian 1 Place of Employment:

Parent/Guardian 1 Work Phone:

Parent/Guardian 2 Full Name:

Parent/Guardian 2 Email:

Parent/Guardian 2 Phone:

Parent/Guardian 2 Place of Employment:

Parent/Guardian 2 Work Phone:

LIABILITY/MEDICAL RELEASE

RELEASE OF ALL CLAIMS

Program, we, being the parent(s) or legal guardian(s) of , do release and agree to hold harmless Marrable Hill Chapel, Victory Bible Camp, and the director thereof from any and all liability, claims, or demands for personal injury, as well as damage and expenses, of any nature that may be incurred by the parent/guardian and participant that occur while the participant is participating in the above described camping trip and activities. Also, I understand students may be photographed or videotaped for promotional purposes.

We, on the behalf of our participant, assume all risk of personal injury, damage, and expense as the result of participation in all activities involved.

AUTHORIZATION AND PERMISSION are given to said camp to furnish any necessary transportation, food, and lodging for our participant. We, as parents/legal guardians of the participant, give our permission for him/her to participate fully in the trip/activity. We give our permission to take said participant to a doctor or hospital and authorize medical treatment, including but not in limitation to emergency surgery or medical treatment, and assume the responsibility of all medical bills, if any. We understand that we will be contacted if at all possible and that our family physician will be contacted if possible, but in the event that he/she cannot be reached, the camp director may choose a reputable physician. Should it be necessary for the participant to return home due to medical reasons, disciplinary action, or otherwise, we assume all transportation costs.

I understand typing my name in the signature boxes constitues an electronic signature and agree to the conditions set forth.

Father's Signature:

Mother's Signature:

(Both parents must sign, unless parents are separated or divorced in which case the custodial parent must sign.)

The signatures will be automatically dated upon submission.

Financial Assistance

Does your camper need a Scholarship?

How much are you paying online today?

CREDIT or DEBIT CARD