Grade 5-7 Overnight #1 July 15-19 Form

Grade 5-7 Overnight Camp #1 2019

Camp runs July 15 - 19. Please fill out 1 form per camper. If you would like to pay your fees online, click the link that is in the Thank You email that you will receive after you hit submit to access our secure online donation page.
  • Camper Information
  • first Name
    last Name
  • /
  • Family Information
  • first Name
    last Name
  • Camper Medical Information
  • Please tell us the camper's height is in ft and inches
  • Please tell us the camper's weight in lbs.
  • i.e. heart conditions, balance problems, joint pain, sprains, muscle weakness, diabetes, seizure disorders, asthma, mental health disorders, high blood pressure.
  • i.e. allergies to food, insect bites, animals, plant life etc
  • i.e. Tylenol, aspirin, prescription medication.
  • Activity Options
    NEW THIS YEAR!! Campers can not choose their activities.
    *NOTE: some activities cover 2 activity periods. If you select one of these activities for period 1 and 3 select the Not applicable option for period 2 and 4
  • Fears and Phobias
  • If there is ONE friend that you know is coming to camp please list his/her name below. THERE IS NO GUARANTEE THAT THEY WILL BE IN THE SAME CABIN!! If more than one name is listed, ONLY the first name listed will be considered!
  • I give Pinelodge Bible Camp permission to contact me by email with information regarding upcoming events, important camp information, financial needs and other inquiries. (JUST A NOTE: if you give permission now and for whatever reason you change your mind, you can unsubscribe at any time by simply clicking the unsubscribe button that is at the bottom of every email we send out and you will be removed from our email list)
    *Medications need to be picked up before the camper leaves the camp grounds.
    *The cost of prescription drugs needed during camp will be paid by the parent or guardian.
    *Parents will be notified by the camp of any illness or injury that may occur during the camp.
    *Emergency intervention will be administered to a child considered in distress, pending safe transport to nearest medical facility.
    *I agree to co-operate fully with camp staff in the event of a disciplinary/behaviour issue with my child.
    If you do not accept terms and conditions your camper registration will be rejected.
    *Photos of campers or family members attending may be used for promotional purposes.
  • PLEASE NOTE: If you would like to pay your fees online, click submit and then go to to access our secure online donation page. If you do not want to give at this time, feel free to close this window after submitting this form. Your registration will still be accepted.


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