Junior High – Boys

$200.00

In stock

Camper Information
First name *
Last name *
Birthday *
School *
Grade next fall *
Phone *
Address *
City *
State *
Church affiliation *
Emergency phone *
Shirt size *
Is the person submitting this registration the parent or legal guardian of this camper?* *
* If No, properly completed legal documentation with evidence of your authority to register this camper MUST be received by the camp registrar TEN DAYS PRIOR TO CAMP.

Medical information
Physician's name *
Physician's phone *
I understand that my medical insurance is the primary insurance for my student and that Camp Fircroft insurance may not be adequate or may not apply to any injury my student might receive. The student named above is covered by medical insurance as follows:
Insurance company *
Policy or group number *
Camper limitations *
Please state any restrictions, physical impairments and necessary limitations of activities, or enter "none." If special consideration at camp may be necessary for this camper, please contact the camp dean or registrar in writing TEN DAYS PRIOR TO CAMP.
Allergies *
List allergies or enter "none." Please state the reaction to all allergies listed.
Medically required dietary restrictions *
List restrictions or enter "none."
Are all immunizations up to date? *
If not, list any missing, or else enter "yes."
Date of last tetanus shot *
Other medical or health issues
Medication Policy: All medications, including over-the-counter, brought to Camp Fircroft MUST be checked in with the camp medical staff at registration. All prescription medications MUST be in the original container with the camper's name, name of medication and directions clearly marked on the pharmacy label by the pharmacist. If a prescription changes from that on the label, a written prescription for the changed dose MUST accompany the bottle. All over-the-counter medications MUST be in the original container and accompanied by parental instructions. Medications not complying with this policy will NOT be given.
Current prescription medications *
List medications or enter "none."
The following medications may be administered when deemed appropriate by the Camp nurse or medic. Please check any medication the camper should NOT receive (check N/A if all are ok). * Benadryl/Diphenhydramine Hydrocortisone 1% Cream Ibuprofen/Advil/Motrin Aspirin Imodium Triple Antibiotic Ointment Throat Lozenges Betadine/Bactine/Hibiclens Claritin/Loratadine Calamine/Calydryl Tylenol/Acetaminophen Tums Mylanta/Maalox Refresh Plus Eye Drops Aloe Vera Gel with Lidocaine N/A
I have read and understand the no-lice/nit policy *
Camp Fircroft No-lice/nit Policy: There will be a required head-check for all campers on registration day. Affected students will be required to return home for at least 24 hours for treatment before returning to camp. Returning students will be rechecked before being admitted to camp.

Terms and Conditions
I authorize the person in charge of first aid duty at Camp Fircroft to administer first aid as required for illness or injury. In the case of emergency, I understand that all reasonable attempts to contact me at the phone numbers provided in this registration will be made. However, if I cannot be reached, I hereby give permission to the physician or dentist selected by Camp Fircroft to hospitalize, secure proper treatment for, and to order injection, anesthesia, or surgery for my child/children (named above). I further authorize the camp to use photos or videos taken of my child at camp for Camp Fircroft promotion and advertising including print media for camp brochures, articles, and camp website. In addition, some activities may be offsite. (Transportation will be provided by the camp for such events.) At no time will camp photos be used by unrelated organizations. Liability Release for Paintball: Fircroft adult staff supervision will do everything possible to keep every camper safe during this activity; however, even with the best of planning unforeseen events can occur. By submitting this registration, the parent/guardian agrees to assume and accept all risks and hazards inherent in this activity. They also agree not to hold this camp or its staff, volunteers, or partner churches liable for the damages, losses, or injuries to their child or property. The parent/guardian understands that they are granting authorization for the minor listed on this registration. This liability release is valid one year from the signed date. Additional Paintball Information: Fircroft supplies facemasks, paintballs, and guns for play. Students may bring their own paintball guns - their use is subject to the approval of the range master. All participating students must submit a waiver signed by a parent or legal guardian and must be properly equipped before playing. Clothing recommendations: 1. Loose-fitting, thick clothing like a thick sweatshirt. Guys may want to consider wearing a cup. 2. A baseball cap worn backwards is a good idea for protection of the top of your head and back of neck. 3. You are welcome to bring your camouflage gear! Adult Supervisors will enforce safety and rules of play during all paintball games. Any camper failing to obey these rules may lose playing privileges for that day or week.
Phone number of person submitting this registration *
Today's date *
Submitted by *
By submitting this registration I affirm that I am the parent or legal guardian of the above camper unless otherwise indicated, and I agree to the Terms and Conditions above.