2022 NWD MS Camp Registration -- North Point Church

Please fill out this form completely to fully register as a camper for the NebWyoDak Middle School Camp.

• July 10-15, 2022 •

After May 31st registration prices will see a $40 LATE FEE increase. So register early for your benefit and our camp leadership's preparation.
CAMPER REGISTRATION

 
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FIRST TIME CAMPER?

Please select all that apply.
 
PARENT/GUARDIAN INFORMATION

In case of emergency, please notify person below:
 
 
 
 
 
 
INSURANCE & MEDICAL EMERGENCY AUTHORIZATION

NebWyoDak Camp’s insurance is a supplemental policy, and it is not intended to fully cover any accidents or sicknesses that may occur at camp. The policy provides only limited coverage for medical payments. Any claims filed will be applied to both the camper’s primary insurance and the Camp insurance. Please include all primary insurance information on the registration form.

For the following, please respond to all that apply:
 
 
 
 
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Medication must be in it's original box or container with the pharmacy's printed labeled information.
Medication must be turned in to the nurse upon arriving at the camp.
Any medication prescribed between the submission of this registration and arrival at camp should still be turned into the camp nurse with proper instructions.
 
 
 
 
 
 
 
 
 
 
 
 
PARENT/GUARDIAN AUTHORIZATION

The Health history is correct, and the above named camper has my permission to engage in all program activities, except as noted above. In case of emergency, I grant permission to the attending physician to employ such diagnostic procedures and medical treatment as deemed necessary. If noted below, I will also grant permission for the camp nurse to administer over the counter (OTC) medications as deemed necessary for the above named camper.
Please select all that apply.
PHOTO & VIDEO PERMISSION

I, As the parent/guardian of this camper (check appropriate box below), give permission to NebWyoDak Camps to include my child’s participation in photo or video recordings that are shared publically or for promotional materials. 
Photos are shared in our invitation only Facebook page and can be reviewed and removed at a parent/guardian's request. 

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PARENT DIGITAL SIGNATURE

 
 
REGISTRATION PAYMENT

$160
 
 
 
 
 
 

Description

Please fill out this form completely to fully register as a camper for the NebWyoDak Middle School Camp.

• July 10-15, 2022 •

After May 31st registration prices will see a $40 LATE FEE increase. So register early for your benefit and our camp leadership's preparation.