Jr. Camp Registration Camper Name *Street Address *Apartment, suite, etcCityState/ProvinceZIP / Postal CodeLegal Guardian Name *Home Phone *Guardian Cell Phone *Guardian Email AddressCamper Age *Camper Last Grade Completed *Camper Gender *Camper T-shirt Size *Physician Name and Phone NumberBlood TypeCurrent Medications (OTC and Prescription)Physical or Mental DisabilitiesEmergency Contact and Phone Number *Food and/or Medical AllergiesRelease and Consent to Treat *The above-named minor has my permission to attend Victory Baptist Church’s summer camp at the 4H Center in Columbiana, AL from July 20 – July 22, 2026. I will not hold the church, its pastors, counselors, or other workers responsible for any injury and/or accident sustained or any illness and/or condition contracted by my child. I, the undersigned, also hereby give my permission to any hospital physician and staff to treat my child while a camper at the 4H Center, if such treatment is deemed necessary by the camp nurse, or in his/her absence, the camp director. It is my understanding that in case of major illness, injury and/or question by the camp nurse, I will be contacted prior to treatment if possible.Signature or Parent/Guardian *Camper Rules Agreement **I have read and do understand the rules of Victory Baptist Jr. Camp 2026 and agree to abide by them.*Signature of Camper/Counselor *SubmitPlease do not fill in this field. Share this: Share on Facebook (Opens in new window) Facebook Share on X (Opens in new window) X Email a link to a friend (Opens in new window) Email Print (Opens in new window) Print Like this:Like Loading…
