WEEK of CAMP STUDENT Is ATTENDING
Please indicate which week of camp this student or adult is attending.
* Note: if, for any reason, you are attending both weeks of camp, please fill out the form for each week.
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:
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.
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.
PLEASE PAY YOUR REGISTRATION FEE TO THE CHURCH YOU ARE ATTENDING WITH.
*$95 Deposit is due with pre-registration and full amount is due by July 1
* After May 15th, a late fee of $40 will be added, raising the registration fee from $295 to $335.
* A full refund can be given if requested before May 15th.
* A partial refund (50%) can be given if requested after May 15th, and before July 1st.
* After July 1st we will not issue refunds. By this point in the calendar year we have purchased resources and confirmed with the camp grounds numbers for which we are now financially responsible.
No registrations accepted after July 1.
