CCOC Camp Registration

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Register a Camper

Thank you for your interest in the Cincinnati Church of Christ Summer Youth Camps. To begin registration, please enter the grade that your child will be in starting fall 2013.

General Camper Information

Full Name:
Date of Birth:
Email:

Gender:
T-Shirt Size:
Allowed to play paintball:

Parent/Guardian Information

Full Name:
Email:
Primary Phone:
Second Phone:
|

Home Address:
City:
State:

Current Church:
Other Church:

Medical History (1/2)

Please list all allergies.
Describe child's reaction and how managed.

Medical History (2/2)

Can you answer "yes" to any of the following? If so, please explain in the box below.

Medication Disclosure

Please list all medications, prescription and non-prescription, taken routinely. Be sure to list the medication name, dosage, time of day taken, and the reason for taking.

Ensure that the camper brings enough medication to last the entire time at camp in the original package/bottle that identifies the camper's name,
prescribing physician, name of drug, dosage and frequency. All medications need to be given to the Camp Health Officer upon arrival.

Over the Counter Medications

Aspirin
Sudafed
Ear Drops
Midol
|

Ibuprofen
Robitusin
Maalox
Visine

Acetaminophen
Antibiotic Ointment
Throat Lozenges
Antacid

These over the counter medications are available from our First Aid Station. They may be administered as deemed necessary by the Camp Health Officer, unless otherwise advised. Please check the box next to any medications you do NOT want administered.

Emergency Contact (Other Than Parents)

Full Name:
Relationship:
Phone:
|

Medical Insurance

Company:
Policy Number:
Group Number:
Claims Address:
Phone:
|

Release e-Signature & Terms Agreement

Please enter your Full Legal Signature below, today's date, and agree to the terms.
Full Legal Signature:
Today's Date: Under penalty of perjury, I certify that the above is my Full Legal Signature, and that I have entered today's date.
I have read the camp brochure, and agree to the terms and conditions contained within.