Kootenay Covenant Bible Camp Registration Form Camp applying for

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					Kootenay Covenant Bible Camp Registration Form Camp applying for: Junior or Teen
             Please register before July 1st (After July 1st Call Registrar 250-428-9089)
(Please Print Clearly. Form MUST be signed by parent/.guardian otherwise we cannot accept child for camp)
BC Medical # or Insurance Co. & Policy #   Last Name ___________________
________________________________           First Name___________________
Allergies_________________________         Age ___ D.O.B. ________M / F
Parents or Guardian’s Name(s)              Camper’s Home Mailing Address         First summer at
________________________________           ____________________________          KCBC Y / N
Home Phone (___)________________           ____________________________
Emergency Contact_________________         ____________________________
Emergency Phone (___)______________        To be released to:___________________
Church _________________________           at the end of camp
Parental/Guardian Consent and Medical Release My Signature below indicates the above named person has permission to
engage in all camp activities, on and off camp grounds, to be transported, and to participate in outings and field trips off Kootenay Covenant Bible
Camp grounds, except as noted. I support the camp administration in enforcing camp rules and accept responsibility for payment of property
damaged by my child. I understand that my child could be sent home if she/he does not adhere to the rules. I also understand that if emergency
medical treatment is required every effort will be made to contact me. In the event that I cannot be reached, I give permission to KCBC to arrange
necessary emergent medical related care and if necessary hospitalization, for the person named above.
           I agree to the release of any records necessary for insurance purposes. I will speak directly to the CAMP DIRECTOR before
removing my child, at anytime, from the camp grounds. This completed form may be photocopied for trips out of camp.

Signature of Parent or Guardian:______________________________Date___________
                                                            (SIGNATURE REQUIRED)
The agreement below must be signed by each individual camper and by his/her parents or legal guardian. If you have questions, please call the
    camp director of your camp. See brochure for numbers.
Our Promise To You
    The Director and Leaders of Kootenay Covenant Bible Camp promise to provide a safe place for the growth of the
    whole person. Our effort will be to generate a physical, social and spiritual atmosphere that is nurturing, creative, and
    joyful. Our focus will be to stimulate an environment in which God can move and the Holy Spirit can work..
Your Promise To Us
    I recognize that KCBC is a Christian camp and that my behaviour, language, dress and attitudes will be encouraged in the direction of
    developing a Christ-like character. As a camper, I promise to treat the camp leaders and staff with respect and to abide by their decisions and
    guidelines for the week. I Will obey all camp curfews and will not leave the grounds without permission. I understand that the use of
    tobacco, alcohol, and Illegal drugs are not permitted at camp and that all prescription drugs must be handed in to the camp First-Aid person. I
    also will not bring pets, electronic devices, or trading cards to camp. Where possible I promise to participate in all scheduled camp activities
    and cooperate with energy and enthusiasm. I promise to respect and enjoy my fellow campers and avoid hurting them physically or by verbal
I have read the camp guidelines and promise to keep them. I understand that failure to keep the above promise could mean that I will be sent home
    early, forfeiting all of the camp fees that have been paid.
Signature indicates that I understand and agree with the above statement.

Student Signature________________________________________ Date:______________
Guardian Signature_______________________________________ Date:______________
Canadian campers mail to:
KCBC Registrar, Laura Nelson
Box 77 Erickson, BC. V0B 1K0 Canada
(U.S. campers see info. in brochure.)

Cabin Mate Request: ______________________
Please note that this is just a request and placement is not

Registration Fee:
A$25 deposit is required                                  $

Family Discount 3+ (-$25 each)
Amount PAID
Balance Due (upon arrival)
Please make all cheques payable to:
Kootenay Covenant Bible Camp