Medical Information

Does the camper take medication? Either prescribed or or over-the-counter.*
YesNo

Please Specify

Does the camper have any allergies?*
YesNo

Please Specify

Date of Last Tetanus Shot - (to the nearest year is ok)*

Any other medical concerns?*

Primary Doctor Name*

Doctor Phone Number*

Medical Insurance Provider*

Name of Insured*

Policy Number*

Insurance Co. Phone Number*

Picture of insurance card (or send in mail after registration)

Medical Consent & Release
In the event of a medical emergency, and I cannot be reached during my child’s participation at CRC, I give permission to the doctor selected by CRC to secure treatment, hospitalize, perform surgery, and prescribe medications as deemed necessary to protect my child's health and well-being. I also authorize CRC to administer any medication, whether brought by the camper or available here (such as acetaminophen, ibuprofen, or other non-prescription drugs) as deemed advisable by the camp staff or a doctor, and to administer first aid when necessary. Further, in signing this form, I hereby certify that I give permission for my son or daughter to participate in the camping program of CRC. I release CRC, its agents, employees, or representatives from all claims or actions from the above named minor child participating in camp.
Permission Granted

Liability Waiver
In consideration of my participation in any way in the events and activities of Christian Resource Center, the undersigned acknowledges, appreciates, and agrees that: The risks of injury and illness (ex: communicable diseases such as MRSA, influenza, and COVID-19) from the activities involved in these programs are significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce these risks, the risks of serious injury and illness do exist; and, FOR MYSELF, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, and assume full responsibility for my participation; and willingly agree to comply with the programs stated and customary terms and conditions for participation. I HEREBY RELEASE AND HOLD HARMLESS Christian Resource Center; its directors, officers, officials, agents, employees, volunteers, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“Releasees”), with respect to any and all injury, illness, disability, death, or loss or damage to person or property incident to my involvement or participation in these programs to the fullest extent permitted by law. I HEREBY INDEMNIFY AND HOLD HARMLESS all the above Releases from any and all liabilities incident to my involvement or participation in these programs to the fullest extent permitted by law. I understand the seriousness of the risks involved in participating in this program, my personal responsibilities for adhering to rules and regulation, and accept them as a participant. By registering for camp, you are allowing CRC to use photographs and videos in promotional material.
I accept

Christian Resource Center

Furthering Christ's Kingdom through Christlike Service

Travel Camp Registration

Camper Information

Parent Information

Medical Information