May Youth Retreat Camper Application

Parent/Guardian Name*

First

Last

Relationship to Camper(s)*

How many campers are applying at this time?

Address*

Street Address City State Zip Code

Phone*

Alternate Phone*

Email*

Home Congregation

Emergency Contact Name*

First

Last

Emergency Contact Relationship to Camper(s)*

Emergency Contact Phone

Emergency Contact Alternate Phone*

Agreements and Signature

I agree that Weeki Wachee Christian Camp may use photographs or video of the camper with or without the campers name and for any lawful purpose.

I have read and understand the Camp Rules, Dress Code, and Cabin Assignments.*

I understand Check-out is at Noon on Sunday.*

I understand responsible adults act as lifeguards during swim time, but may not have an active lifeguard certificate. I understand that first aid will be available and administered if necessary at the camp and that if serious injury or illness develops, medical and/or hospital care will be given. I further understand that in case of serious injury or illness I will be notified; but if it is impossible to contact me, I give my permission for emergency treatment and/or surgery as recommended by the attending physician. (Included in the camp fee is a group insurance policy covering accidental injury to campers at camp above family insurance). The camp and/or staff, however, will not be held responsible in case of illness or accidental injury.*

I verify that all the information provided in this application is true and accurate to the best of my knowledge. *

The electronic signature below and its related fields are treated by Weeki Wachee Christian Camp like a physical handwritten signature on a paper form.

Electronic Signature*

Date*

Select Payment Method*

Payment

Campers = $40.00 each

Number of Campers*

Total Online Payment

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Upon clicking Submit your application and payment will be processed and a confirmation email will be sent to the Parent/Guardian email address provided.