Keystone Camp Signup Form - Keystone Mennonite Fellowship

Keystone Camp Application

Please select the camp you are registering for.

Rubies Girls Camp

Arrows Boys Camp

First Name

Last Name

Age (age on the first day of camp)

Date of Birth

Parents names

Full Name

Address

Address Line 1

City

State

Zip Code

Country

Parents Email

Parents Phone Numbers

Phone

What Church do You Attend?

Church Affiliation

Emergency Contact (other than a parent)

Emergency Contact Phone/Mobile

Serious Injuries/Operations in the Recent Past

Activites limited/restricted by a health care provider

Disability/Chronic Illness

Physical/Emotional/Mental Handicaps

Dietary Modifications

Current Medication (send along with instructions)

Any other health care concerns/details

Family Doctor

May we call you after 10pm if your child is homesick?

Yes

Other allergy (please specify)

Tetanus Shot (I confirm that my child has had one in the last 10 years. If not I am aware of the risks and am responsible for the cost if one is needed during camp.)

Yes

Roommate Preference (select only one)

This health history is correct so far as we (I) know, and the person herein described has permission to engage in all prescribed camp activities except as noted. Authorization for treatment: If we (I) cannot be reached in an emergency, we (I) permit the medical personnel selected by Keystone Camp personnel to secure and administer treatment including X-rays, routine tests, hospitalization, and necessary related transportation for my child. We (I) hereby release and covenant with Promised Land Camp and Keystone Mennonite Fellowship that we (I) will never, individually or as legal guardians of said individuals, institute any action at law or in equity for any personal injuries, or injuries to property, real or personal, caused by, or arising out of, camping and other related activities sponsored by Promised Land Camp and Keystone Mennonite Fellowship, its successors and legal representatives.

For Rubies Girls Camp, we ask that each young lady dress modestly in all camp activities. We require that all campers wear dresses or skirts and blouses with sleeves. Skirts need to be of sufficient length to cover the knees at all times. Loose-fitting, full-length pants (under the dress/skirt) or skorts may be worn for select activities, but they need to be changed into regular clothes (no skorts) for the rest of camp activities. (If appropriate clothing is not brought to camp, you will be asked to pick up your child or bring acceptable clothing for them.) No jewelry or clothing with pictures/writing. Promised Land Camp has a no barefoot policy.

I understand this website will redirect me to PayPal for payment processing, and I agree to PayPal's terms of service found here. I also understand that the registration down-payment fee is NON-REFUNDABLE once accepted into camp.

Non-refundable downpayment

Price: $50.00