2004 Camper Registration Form

							                                           2009 Camper Registration Form
Early Bird Deadline: 5/1/09                                Regular Deadline: 5/15/09
Registration Form may be submitted with $25 non-refundable deposit before deadline.
After deadline, please call to check on available space. Please DO NOT send campers without registering.

Name:                                                                Phone:
                                                                                                                     Covenant Bible Camp
Address:                                               City:                          State:         Zip:
                                                                                                                      Unalakleet, Alaska
Birth date:                       Grade Completed:                  Weight:          Gender:       M or       F          907-373-2322
Email: _______________ Emergency contact:                                            Phone:                        www.cyak.org/about/cbc.html

   Leadership Camp –grades 9-12 May 27-June 1 - $95 Early Bird, $120 Regular,                                          For Office Use Only
                                                                                                                   DR _____
   Senior High –grades 9-12 June 1-8 - $120 Early Bird, $145 Regular            * $25 fee for registrations        AR _____     FOP ______
   Junior High –grades 7-8 June 8-15 - $120 Early Bird, $145 Regular           after the regular deadline,         RG _____ TR _______
                                                                                                                   AD _____ SM _______
   Trailblazers –grades 5-6 June 15-20 - $95 Early Bird, $120 Regular           call to confirm if there is        AR _____     FOP ______
                                                                                                                   RG _____ TR _______
   Pathfinders –grades 3-4 June 20-25 - $95 Early Bird, $120 Regular            space available.
                                                                                                                   SM _____     AD _______
TRAVEL: If camper will travel to Unalakleet please complete the travel information in the box:                     BR ______ SM ________

NORTON SOUND REGION                            OTHER ALASKA REGIONS
Please make your own arrangements with a           I would like Covenant Bible Camp to make travel arrangements. Camper will
commercial carrier—ask for Bible Camp              travel on the dates chosen above unless other arrangements are approved.
rates. Camper should travel on the dates           Please enclose the following for roundtrip flights to Unalakleet:
chosen above unless other arrangements are          Y-K Delta and Kotzebue Regions $
approved. Camper will travel with:                  Anchorage/Soldotna $
   Bering Air         Hageland Aviation             I will make travel arrangements on my own, with
The last night of camp, the campers are brought to Unalakleet to prepare for travel. Please choose one of the following:

   In Unalakleet, camper has permission be released to                                     at                     (phone #).
   I understand that this person will be responsible for camper and for getting camper to the airport to travel home.
   Camper will stay at the Covenant Youth Facility under the supervision of the camp staff and travel home the day camp ends.

Medical problems? Allergies? Medications?             No       Yes—Please explain:



I/We                                                     , the parents/guardians of
(The minor child), and said minor child voluntarily release COVENANT BIBLE CAMP, THE EVANGELICAL COVENANT CHURCH
OF ALASKA and REPRESENTATIVES thereof from any suit, damage, action or any other claim of any nature, as well as the
hosting church and activity supervisors. In case of any emergency, I/we give permission to secure proper treatment for my
child as needed. I consent to any x-ray exam, anesthetic, medical, or surgical diagnosis or treatment. I also understand the
camp staff may discipline or send my child home without refund if he/she does not comply with camp rules.

                                                                                                                  Date
Parent/Guardian Signature                                                       Printed Name

CAMPER PROMISE: I promise to obey all camp rules. I agree to stay on camp grounds during the camp session unless I have
the permission of the Camp Director. I understand that I may be sent home for not obeying camp rules.

                                                                                                                  Date
Camper Signature (IF 18 or older you don’t need parent signature)               Printed Name
                                       Please make check or money order payable to Covenant Bible Camp. Mail registration and fees to
Registration:          ________
                                       Covenant Youth of Alaska 5201 Mayflower Lane Wasilla, AK 99654. Forms may be faxed to
Travel (if applicable):________        907-376-7729. A $25 deposit needs to be made by deadline to reserve spot. Space is
                                       limited! Deposit is NON-REFUNDABLE.
Spending Money*:       ________
                                       If you would like to pay with your Credit Card please call 907-694-6348. For all other questions
Donation:              ________        please call 907-373-2322. After May 23rd call 907-624-5050.
                                       Family Discount— Pay full price for the oldest child, and receive 25% off registration for
Total Enclosed:        ________
                                       others in the same household. Send forms together and by the deadline to receive discount.
                                       *Spending money is held on account for camper for canteen and offerings. $25 or less.