Late Registration Registration 2023 Early Registration: $240 until June 9th Late Registration: $265 June 10th-June 24th Registration Deadline: June 24th (Or when cabins reach capacity. Age groups may fill up at different times. No extra beds will be added to cabins.) Step 1 of 5 – Camper Information 0% Camper Name* First Last Sex* Male Female Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Please make sure you choose the CORRECT year of birth.Entering Grade Next School Year:*Choose Grade456789101112GraduateHome Church Home Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Parent Cell Phone*Home Phone Parent / Guardian Name* First Last Parent / Guardian Email* Parent / Guardian Address Different than Camper Parent / Guardian Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Emergency Contact Name* Emergency Contact Phone* Camper Acknowledgement* I, as a camper, understand what I am allowed to bring with me to camp and what I am not allowed to do at camp, as stated on the FAQ page. **I may bring my phone but will turn in any electronic devices (including my cell phone) upon arriving at camp when I check in. I understand that it will be returned to me on the last day of camp. I will follow the dress code rules and only bring/wear fingertip length shorts and appropriate tops. I understand that failure to comply with camp policy may result in my parents being notified and/or my being sent home. Parent Acknowledgement* I, as a parent, understand what my child is allowed and not allowed to bring with them to camp, as stated on the FAQ page. I understand that my child’s shorts must be fingertip length and that they are not allowed to keep cell phones in their cabins. I have explained these rules to my child. My child has permission to swim at camp.* Yes No How will your camper ARRIVE at camp?* On Church Bus With Parent / Guardian Which congregation's transportation?* Name of person with whom camper will be riding?* How will your camper RETURN home?* On Church Bus With Parent / Guardian Which congregation's transportation?* Name of person with whom camper will be riding?* Nurse InfoThe following Nurse Info step is required to complete before coming to camp. Please read and answer every question carefully.Do you have medication or food allergies?* Yes No If yes, what? Please describe reactions? (i.e. rash/difficulty breathing . . .)* Do you have permission to take non prescription over the counter medication? (i.e. Tylenol, Benadryl, etc.)* Yes No Consent* Parents, by checking here, you give consent by digital signature to either allow or not allow the over the counter meds listed above. Past Medical History: Please answer yes or no to each.Heart problems* Yes No Kidney or bladder problems* Yes No Lung (i.e. asthma)* Yes No Neurological or mental* Yes No Diabetes or thyroid* Yes No Stomach/intestine/liver* Yes No Other* Yes No Please describe Have you had surgery within the last year ?* Yes No If yes, please describe:* Will you have medicine with you?* Yes No If yes, please list all prescription and non-prescription medications you will bring to camp. NOTE: All medications, must be in their original containers. All prescription medications must have original pharmacy label on container with camper’s name in order to be dispensed at camp. List daily and as needed medications your child will/may take at camp. List on back of sheet if necessary.Name of Med.* Strength (mg)* Time to be taken* Reason for med.* Name of Med. Strength (mg) Time to be taken Reason for med. Name of Med. Strength (mg) Time to be taken Reason for med. Name of Med. Strength (mg) Time to be taken Reason for med. HiddenHave you had a tetanus shot within the last six months?* Yes No Have you had or been immunized for:* Measles Mumps Chicken Pox Diphtheria Whooping Cough none **CONSENT REQUIRED FOR CAMP ATTENDANCE:Consent* I/We hereby DO give permission for the director and/or camp nursing or admin staff to take my camper to the hospital or to see a doctor in case of accident or sickness and to receive medical treatment as prescribed by an attending physician. I/We also acknowledge an understanding that camper health information may need to be shared with camp staff to ensure a safe camp experience. Confidentiality of camper health information is an important aspect of providing camp health care, along with keeping camp staff informed of camper needs. I/We understand the youth camp will not be held responsible for this camper, and I/we will never bring any legal action against Bandina Christian Youth Camp, Inc., its staff members, or participating churches. I/We hereby DO NOT give permission for the director and/or camp nursing or admin staff to take my camper to the hospital or to see a doctor in case of accident or sickness and to receive medical treatment as prescribed by an attending physician. I/We also acknowledge an understanding that camper health information may need to be shared with camp staff to ensure a safe camp experience. Confidentiality of camper health information is an important aspect of providing camp health care, along with keeping camp staff informed of camper needs. I/We understand the youth camp will not be held responsible for this camper, and I/we will never bring any legal action against Bandina Christian Youth Camp, Inc., its staff members, or participating churches. Consent* I/We DO give permission for to swim while at camp. In case of an accident I/we give authority and consent for medical and surgical treatment as needed in the judgment of treating physicians. I/we also agree to never bring any legal action against Bandina Christian Youth Camp, Inc., its staff members, or participating churches. I/We DO NOT give permission for to swim while at camp. In case of an accident I/we DO NOT give authority and consent for medical and surgical treatment as needed in the judgment of treating physicians. I/we also agree to never bring any legal action against Bandina Christian Youth Camp, Inc., its staff members, or participating churches. I HAVE explained to my camper that they are NOT allowed to swim at camp. T-Shirt Size*Choose one…Child LargeChild XLAdult SmallAdult MediumAdult LargeAdult XLAdult XXLBase Registration Fee* Price: Extra ClassAll campers should select from the following “extra” class options. Assignments will be made on a “first come” basis. Please note that some classes have age limitations and/or fees. Any fees charged for classes you do NOT get into will automatically be added into your canteen fund to use or be returned at the end of the week. Visit our Classes page for details about each class offering. BELOW: Please select your first, second, and third preferences from the following drop-downs. Be sure to select unique choice from each drop-down. Class Choice 1*Choose one…Cooking (all ages) $10.00Fishing (all ages)Golf (all ages)Painting (all ages) $10.00Sign Language (all ages)First Aid (all ages)Archery (all ages)Creative Arts (9-11 year olds) $10.00Pop Culture / Media (ages 15-18)Woodworking (ages 15-18) $15.00Yoga (ages 15-18 females)Class Choice 2*Choose one…Cooking (all ages) $10.00Fishing (all ages)Golf (all ages)Painting (all ages) $10.00Sign Language (all ages)First Aid (all ages)Archery (all ages)Creative Arts (9-11 year olds) $10Pop Culture / Media (ages 15-18)Woodworking (ages 15-18) $15.00Yoga (ages 15-18 females)Class Choice 3*Choose one…Cooking (all ages) $10.00Fishing (all ages)Golf (all ages)Painting (all ages) $10.00Sign Language (all ages)First Aid (all ages)Archery (all ages)Creative Arts (9-11 year olds) $10Pop Culture / Media (ages 15-18)Woodworking (ages 15-18) $15.00Yoga (ages 15-18 females)Anything else you'd like us to know about your camper, special notes, etc…Canteen and Craft Funds*You are ENCOURAGED to add canteen money here. This money is what campers use to purchase additional Bandina swag, canteen, or make crafts during free time. It’s much easier than bringing it to camp with you. Any remaining funds not used will be returned at the end of the week. $0 $10 $15 $20 $25 $30 $35 $40 $45 $50 $60 Total Camp FeesPay Total Camp Fees* Total Camp Fees (amount above) No refunds are given after our June 25th deadline.Amount To Be Charged To Your Card Today Price: $0.00 This is your total of Camp Fee plus any additional canteen or class fees you added.Credit CardCard Details Cardholder Name