Register for Camp!
Camper Name _________________________________________         Birth Date _____________

Address ______________________________________________         Age _____ Grade _______

City/ State/ Zip _________________________________________         Male ___ Female _______

Home Phone ______________________   E-Mail  _______________________________________

Home Church   ___________________________________________________________________

Cabinmate Request  _______________________________________________________________

Parents Name(s)   _________________________________________________________________

Camp/Retreat Attending  ____________________________________________________________

By signing below I am stating that I agree with the following statements...

I give Shiloh Bible Camp Permission to use photos or video of my family in publications. I release my right to any kind of remuneration for said photo or video.

My child has permission to participate in all activities on or off the grounds.

I understand that Lice checks will be administered at registration and the camper could be SENT HOME if lice are found.

I understand and agree that I must give permission before my child recieves any over the counter medications.

We require the you turn all medication over to the Shiloh staff  who will oversee the camper's intake over the week. This is to protect your child and other children. I agree to turn in all medications at registration in the original medicine container.

In case of medical emergency for my child, I understand that Shiloh Bible Camp personnel need the completed Emergency Authorization Form to authorize treatment. By signing below, I am agreeing to fill out this form and sign it. I will sign Shiloh's Medical Release form.

I will either bring payment at registration or mail it with this registration form.

x____________________________________________  Date ______________