MSBC Primary Week 2022

Name*

First Name Last Name

Email*

Gender*

Last Grade Completed*

Birth Date*

Address Line 1*

Address Line 2

City*

State/Province*

Zip Code*

Church You Attend

Baptized?

T-Shirt Size

Bus Pick-up Location

Bus Drop-off Location

Cabin Share Preference

If possible, I would like to be in a cabin with...

Parent/Guardian Info

Parent First Name*

Parent Last Name*

Phone

Secondary Phone

Emergency Contact

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Phone

Medical History

All medical information is strictly confidential. It will be shared only at the director or medical staff's discretion and then only if necessary.

Date of Last Tetanus Shot

Insurance Company

Group Number

Insurance group identifier

Policy Number

All medicines should be given to the camp director or medical staff upon arrival. Read the following and fill in carefully. We will have over-the-counter medicines on hand - Do not send with your child: Ibuprofen, Tylenol, Aspirin, Aleve, Sudafed, Claritin, Robitussin, Tums, Pepto Bismol or Alka Seltzer

Health Problems

Please specify any health problems that might require attention or medicines that must be taken during camp. Also, please us this space to notify us of any food or drug allergies.

Parent Agreement, Medical Consent, Water Sports Permission and Waiver

Terms & Conditions*

By virtue of completing and submitting this registration form, you are acknowledging that you are the parent or legal guardian of the camper being registered. Furthermore, you covenant and agree that the Anchorage Church of Christ, 2700 DeBarr Road, Anchorage, Alaska, will not be responsible for any accidents in which your child may become involved in at Midnight Sun Bible Camp or in going to or returning therefrom. You hereby assume all responsibility for such accidents and any and all medical attention that may be necessary as a result thereof. You also authorize the camp director of Midnight Sun Bible Camp, and others working under him, to obtain medical treatment for your child while they are responsible for him or her. You also acknowledge that you have read the camp rules and regulations and have discussed them with this registered camper and agree to support the decisions the director makes concerning your child. By checking the following water sports, you are indicating this camper has your permission to participate in them.

I have read and agree to the terms and conditions detailed above.

Check all that apply

Water-Skiing (when available)
Knee Boarding (when available)
Tubing
Motor Boat Riding
Fishing from a Boat
Swimming
Canoes
Paddle Boats

If any of the above is not checked, your child will not be able to participate in any of these activities.

Camper Agreement

Camper Agreement*

I have read the camp purpose, policy and rules and understand that they are reasonable and necessary for the success of the camp. I agree that I will do my best to support camp policy and abide by the rules of the camp.

I have read and agree to the terms and conditions detailed above.

Payments

Ticket	Price	Quantity
Primary Week 2022	$220.00	Sold out
Total	$

2700 Debarr Road Anchorage, AK 99508

Event Details

MSBC Attendee Registration