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Camper’s Name

Address—City, State and Zip

. ____________
Grade this Fall
Male Female
Tee-shirt size _____________. 2018
Church Attending Camp With

Please list below preferred cabin mates:

____________________ ___________________

____________________ ___________________

Please list below any medications

presently being taken:

Please list below all known allergies:

Please list below any health problems

that camp staff should be
aware of:

Please sign below if person named
above may go swimming.


. For Information Call Clay Thacker (304)544-5471


(Camper, please read and sign) We the undersigned, being the parents, the parents
Bible, sleeping bag (or sheets and blankets), having legal custody, or the legal guardians of
pillow, washcloth, towels, soap, toothbrush,
1. No one is to leave camp grounds except by toothpaste, swimsuit*, comb, sports & hiking , a minor, and have
permission of camp director. clothes, (old jeans for water slide), shoes given our consent for him or her to attend summer
2. No rowdiness or misbehavior will be (hiking and/or tennis shoes for games), camp July 22 - 27 at Camp Caleb in Blaine, Kentucky.
permitted, and failure to obey and respect socks, flashlight, one bag for dirty clothes and In the event that he/she is injured while at the camp
persons in authority may result in camper one for wet clothes, insect repellent, pencil or and requires the attention of a doctor, we consent
being sent home. pen, jacket, one set of disposable clothes for mud to any reasonable medical treatment deemed
3. Campers should strive to pick up litter day, spending money (snacks, T-shirts, necessary by a licensed physician. In the event
and keep premises presentable at all times. books, crafts, etc.) and notebooks. treatment is called for, which a physician and/or
4. Each camper is expected to do his/her part *one-piece swimsuits ( if 2 piece is worn, a hospital personnel refuses to administer without
in keeping their cabin clean. dark shirt must be worn over the suit). our consent, we hereby authorize Coy Miller,
5. Valuables - such as watches and rings Camp Director, or an official camp adult leader in
should be left at home.
6. No marking, carving on buildings or
DO NOT BRING his absence, to give such consent for us if we can
not be reached by telephone at one of the numbers
Cell phones, IPOD, tablets, laptops, magazines,
removal of flowers, trees, etc. indicated below or, because of emergency, there
water guns, playing cards, fireworks, alcoholic
7. No smoking or use of any tobacco product. is not time or opportunity to make a telephone
beverages, pornographic literature, illegal drugs or
8. It is expected that all campers will participate call. In the event, it becomes necessary for someone
tobacco products of any kind, clothing that has
in all activities scheduled by the camp to give consent for us, we agree to hold such
advertising for rock groups, immorality, or other
director unless noted otherwise by the parent/ person free and harmless of any claims, demands,
questionable slogans, sleeveless shirts or shorts of
guardian on this registration form. or suits for damage arising from giving such
inappropriate length. If parents require campers to
9. Campers are to bring 1 pillow, 1 or 2 sheets consent so long as the treatment is administered
have cell phones, they are to be turned in at the
1 blanket or sleeping bag, sleeping garments, by or under the supervision of a licensed
Camp Office and are only to be used in the office
towels, wash cloth, soap, swimwear, physician.
with permission of Camp Director.
necessary toilet articles, no more clothing
than is absolutely essential, notebook, pen
pencil, BIBLE. WHERE IS IT? Parents
10. No tank tops, no cell phones or IPODS. Camp Caleb Christian Camp in Blaine, KY Telephone #: .
No touching policy. After reading the above, (Approximately 60 miles from Barboursville,
please read the following paragraph and sign: WV) Child’s SS #: .
(Not mandatory to provide SS number)

I have read the above rules, and by signing, agree

to abide by them. All students who will be in the 7th grade through the Signatures of Parent(s) or Guardians(s):
12th grade this school year. There will be 7 people
plus one adult cabin/devotion leader per cabin.
July 22 - 27. We will be arriving at the camp at
Signed Date 6:00 PM, Sunday Evening.

Date .
Note: Mark all clothing and linen with your name. COST
$120 (Includes lodging, meals, transportation) Please fill out other important
information on reverse

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