2024 Bible Presbyterian Church Camp Registration

Camp Date: June 30-July 6, 2024
Camp Location: 3127 W CR 800 South, Greensburg, IN 47240

Cost: $320 if registered by June 16
$340 if registered on June 17, or after
Churches may require separate transportation fee
$100 non-refundable deposit due with registration.
Full payment due by June 23, 2024.
Make checks payable to B.P. Camp Fund

Camp Guidelines for Campers:

∙ Honor all authority including counselors and camp staff. (Rom 13:1, Heb 13:17).

∙ Respect other campers feelings and their belongings. (Rom 12:10)

∙ Language should be God glorifying at all times – swearing, foul or vulgar language will
not be tolerated (Phil 2:3,4).

∙ No personal entertainment devices: Cell Phones, DVD or CD players, PSP’s, mp3’s, etc. (Phil. 4:8).

∙ All music, when permitted, must be understandable and God honoring (1 Cor 10:31).

∙ No public displays of affection or inappropriate behavior – towel snapping, suggestive touching, kissing, handholding, intimidation or threats (1 Th 5:22, Eph 5:3).

∙ Clothing should be modest at all times - Modest bathing suits (no bikini style, no Speedos), no exposed midriffs, cleavage or underwear showing.

∙ No use of or possession of tobacco, alcohol, drugs or weapons (pocket knives included), this is cause for immediate dismissal (Eph 5:18; 1 Cor 10:31).

The following three-step policy is in effect for violations of these rules:

1^st Step: Warning - This warning will be accompanied with a promise to call a parent if there is another problem.

2^nd Step: A call to parent.

3^rd Step: Dismissal (Parent called and camper sent home at their expense).

I have read the above rules and to the best of my ability I agree to abide by them. (Camper signature required by way of name and DOB)

PARENTS:

I have read and completed this section of the form and give my permission for my child to attend the 2024 Great Lakes B.P. Summer Church Camp. I agree that my child may be transported locally to a location near camp for canoeing activities. I understand that Southeastern Baptist Youth Camp and B.P. Churches may be taking pictures and video of my child within the camp setting and that all of these pictures and video will be appropriate and will strictly be used for camp promotion.

Should an emergency arise, the leaders or supervisors of the event have my permission to obtain any necessary medical care for my son/daughter. I agree to defend and indemnify Bible Presbyterian Church Camp, Bible Presbyterian Churches, the Camp Director, its staff and volunteers, Southeastern Baptist Youth Camp, its employees and volunteers against any claim or action that might arise on behalf of myself or my son/daughter other than for willful, wanton, or reckless misconduct of Bible Presbyterian Church Camp and Southeastern Baptist Youth Camp, their employees or volunteers. I also agree that if my son/daughter breaks the above rules and that after the discipline steps above have been taken, I may be notified and he/she may be sent home at my expense before the event is over with no refund.

Parent/Guardian signature by way of name and DOB:

BASIC CAMPER INFORMATION AND MEDICAL CONSENT FORM

Campers Name

T-shirt size:

Which BP Church will you be traveling with/from?

Grace Bible (OH) Grace Reformed (TN) Cornerstone Reformed (MN) Bible Presbyterian Church (NY) Wilson Bible Presbyterian (PA)

Camper Birth Date:

Camper Age:

Which Age Group?

Jr Camper (4th grade - 7th grade) Sr Camper (8th grade - 12th grade)

Grade Entering in the Fall of 2024

How many years has the camper attended BP Camp?

Parent or Guardian Name

Mailing Address

Parent email address

This address will receive a confirmation email

Additional email address

Parent or Guardian Mobile Phone

Parent or Guardian Alternate Phone

If I am not available in an emergency, please notify:

Emergency Contact Name

Emergency Contact Relation to Camper

Parent/Guardian Grandparent Aunt/Uncle Friend of the Family

Emergency Contact Phone

Emergency Contact Alternate Phone

Is there anything spiritual, medical, or personal that you would like your child's Counselors to know about them?

Medical Information

Is this camper on any medication?

Yes No

If yes, what?

Will this camper be bringing this medication to camp? Yes No

All meds MUST be given to the camp nurse in original prescription container or box with the child's name on it. Please provide dosage instructions:

Check any of the following medication that you DO NOT want us to give your camper should the need arise: (may be generic brand) Tylenol or Motrin Benedryl Tablets Hydrocortisone or Antibiotic Cream Tums Antacid Tablets

Please list any (and all) allergies:

Does this camper have any medical or health problems, and has this camper had any chronic or recurring illness(es) which would have an effect on them participating in any activity?

Yes No

If yes, please describe the problem or illness(es) or restrictions on activity:

Primary Care Physician and Insurance Information

PCP Name

PCP Phone

Name of Insurance Policyholder

Insurance Policy Number

Insurance Group Number (if applicable)

Insurance Co. Name

Insurance Co. Address

Insurance Co. Phone

Please provide a copy of your insurance card (front and back) here, by emailing to office@gracebpc.org, by mailing to 12060 Lebanon Rd, Cincinnati, Oh 45241, or by placing a copy in the Grace BP Church office mailbox.

Please designate how you will provide the insurance card information:

Electronically, here on the form Electronically, by way of emailing to the office Paper Copy via mail or drop-off Parent is attending and will have insurance cards on their person Camper is uninsured

Front of Card

Upload (8MB)

Back of Card

Upload (8MB)

I understand that my personal medical and hospitalization insurance available to my family will provide primary coverage and the church or ministries medical and hospitalization coverage (subject to the exclusions, limitations and provisions in the ministry’s policy) may provide secondary or excess coverage. I agree to apply first for benefits from the personal hospitalization and medical coverages available to my family, if any, before applying for benefits that may be available from the church or ministry’s medical and hospital coverage. I further understand that, in the event my child requires medical or dental treatment while engaged in the event or activity, reasonable efforts will be made to contact me; however, if I cannot be reached, I hereby consent and give my permission to the church’s sponsor or any adult counselor acting on behalf of the ministry with respect to the event or activity, as agent for me, to consent to any X-ray examination; injections; anesthesia; medical, dental or surgical diagnosis and treatment; and hospital care and treatment advised and supervised by a physician, surgeon or dentist (as appropriate) licensed to practice under the laws of the state where the services are rendered, either as an outpatient or in any hospital. To the best of my knowledge, I have listed above all my child’s medical allergies, medications being taken, medical problems and other pertinent information. My child has permission to participate in all activities except as noted by me.

Parent or Guardian Signature (initials and DOB)

If you have not filled out the Consent to Transport and Release of Liability form for 2024, please click this link.

BP Consent to Transport & Release of Liability

We take photos of the activities we are involved in and share them on social media and our website. If you do not want your child to be portrayed on these sites, please indicate below.

My child's photo to be displayed on any social media or website:

Yes, that is ok with me. No, that is not ok with me.

Please indicate how you plan to pay for your camper(s)

Online today (see below) Via check or cash

Payment ($320 per camper if registered by 06/16. $340 per camper if registering on 06/17 or after)

Amount

Please completely fill out entire form and attach a copy of both sides of Med. Ins. Card in space provided (or by emailing to office@gracebpc.org, or by placing a paper copy in the Church's office mailbox).

Make checks payable to BP Camp Fund and return to your local BP Church Office. They will mail your registration to:

Pete Gross: 12060 Lebanon Road, Cincinnati, OH 45241

Questions: pete@petegross.net or (513) 827-5413- Pete Gross (Camp Director)

For the Office, only: Memorization Received Insurance ID Received Consent to Transport Received Pay Complete Camper is Uninsured

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

2024 Bible Presbyterian Church Camp Registration

Description

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