Camp Bandina

Elliott Session (Session 8: July 11-17, 2021)

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Step 1 of 5 - Camper Information

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Camper Name*
First Last
Sex*
- Male
- Female
Date of Birth*
Entering Grade*
Home Church
Home Address*
Street Address Address Line 2 City 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 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 return home?*
- On Church Bus
- With Parent / Guardian
Which congregation's transportation?*
Name of person with whom camper will be riding?*

Nurse Info
I understand that each camper is required to complete and provide a medical release form where I will provide a list of meds that my child will be bringing to camp, if applicable. It is REQUIRED that the Medical Release Form be mailed or emailed BY the camp deadline. You MAY NOT bring the form to camp with you.
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 medication? (i.e. Tylenol, Benadryl, etc.)*
- Yes
- No
Consent*
- Parent, please sign giving permission for camp nurse to administer
Past Medical History: Please answer yes or no to each, explain on separate sheet if necessary.
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
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 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.
Have 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
- Other
**SIGNATURES REQUIRED FOR CAMP ATTENDANCE:
Consent*
I/We hereby do/do not give permission for the director and/or camp nursing staff to take 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/do not 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.
Nurse Info*
- I understand that each camper is required to complete and provide a medical release form where I will provide a list of meds that my child will be bringing to camp, if applicable. It is REQUIRED that the Medical Release Form be mailed or emailed BY the camp deadline. You MAY NOT bring the form to camp with you.
Please download the Medical Release Form.

T-Shirt Size*
Base Registration Fee*
Price: $225.00
Extra Class
All 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. If you choose 1 or more classes with a fee, please check the appropriate fee option below. 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*
Class Choice 2*
Class Choice 3*
- Class Fee $10
Anything else you'd like us to know...
Canteen Funds*
New 2021 change: Canteen may NOT be brought with you to camp. All funds are due up front.
- $5
- $10
- $15
- $20
- $25
- $30
- $35
- $40
- $45
- $50
- Camp DVD ($5.00)
Total Camp Fees
Ready to Pay Now?*
- $100 non-refundable deposit
- Total Camp Fees (above)
Amount To Be Charged To Your Card Today
Price: $0.00
Credit Card

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name

Medical Release Form

Download a copy of the Medical Release Form, completely fill it out, then scan and email it to [email protected] or mail it to Melissa McAdams, 2960 Auburn Woods Dr. Pearland, TX 77581. This is REQUIRED by the deadline to attend camp.

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Step 1 of 5 - Camper Information

Nurse Info

Extra Class