Family Camp App | The Church of God – North Carolina State Office

"*" indicates required fields

I will be attending as a camper*

Age older than 5

Age younger than 5

Name*

First Last

Age as of June 1*

T-Shirts - $20*

Kids - Small

Kids - Medium

Kids - Large

Adult - Small

Adult - Medium

Adult - Large

Adult - X-Large

Adult - 2X-Large

Adult - 3X-Large

No T-Shirt

T-Shirts have to be paid for in advance.

Date of Birth*

YYYY

Address*

Street Address Address Line 2 City State ZIP Code

Gender*

Male

Female

Phone*

Saved?*

Yes

Sanctified?*

Yes

Holy Ghost?*

Yes

Member of The Church of God*

Yes

Local Church*

Do you hold any positions as a church leader?*

Yes

If yes, please list positions currently held.

Consent*

I agree to the rules below.

Rules for acceptance & participation of camp are the same for each person without regard to race, gender or national origin.

Please do not bring electronics. Camp will not be responsible for lost or damaged electronics. There will be no pillow fighting, water guns or water balloons used inside a building. No shaving cream fighting or playing, illegal drugs, tobacco products, alcohol, fireworks of any kind or weapons of any kind. I understand that when signing this application, I am agreeing to abide by all rules and regulations of the camp. If I break any rule, I understand that I am subject to disciplinary correction even to the expelling from camp.

The Church of God Family Camp Dress Code: To Parents and Campers. This is a Christian Camp. Please dress accordingly. Boys should wear long pants, girls' hemline BELOW the knee (hemlines need to be below the knee while sitting). The following clothes ARE NOT ACCEPTABLE: shorts, leggings/jeggings, tank tops, sheer fabrics, sleeveless tops, no cut-offs, no bare stomach or back showing, no low-cut tops, no shirts with profane words and/or pictures. To all church services - girls should wear dresses or skirts, boys should wear jeans or slacks. If girls choose to wear leggings under their dresses/skirts, the hemline of the skirt still must be below the knee while sitting.
PLEASE MARK ALL PERSONAL ITEMS WITH CAMPER'S NAME. Camping staff WILL NOT BE RESPONSIBLE for missing clothing or items left on campground.

Signature of Parent/Guardian*

Signature of Camper*

If camper is under 5 parent may sign.

List Activities you Do Not want your child to participate in.*

Recreation Activities consist of: Rock Wall, Blob, Zip Line, Large Swing, & Archery. If you prefer for your child to NOT Participate in any of these activities, please list the specific activities above. If they can participate in all of them put N/A.

I give permission for the above-named minor to be baptized in water during camp if they desire.*

Yes

Name of Parent/Guardian*

First Last

Parent/Guardian Phone*

Name of person authorized to pick up camper*

First Last

Health Information

Name*

First Last

Please Check all that apply.*

Rheumatic Fever

Seizures

Fainting

Asthma/Respiratory

Tuberculosis

Diabetes

Kidney Problems

Heart Trouble

Sleep Walking

Poison Ivy, Oak, Sumac

Recent Surgery

None

Please give approximate dates of occurrence in the box below.

Allergic Reactions*

Bee Stings

Drugs

Food(S)

None

Please give more detail of what you are allergic to and your allergic reactions in the box below.

Additional Health concerns, allergies, and/or limitations.*

If you checked any of the boxes other than NONE in the previous two question please give details here. You may also add any additional details of heath concerns in this box.

Please list any prescribed medications.*

All medication is to be given to the camp nurse to administer to the camper unless approved by camp administration. Put N/A if you are not taking any medications.

Insurance Information

Name of Insured*

First Last

Insurance Company*

Group Number*

Policy Number*

Medical Consent by Camper (or by Parent/Guardian if under 18)*

I agree to the medical consent below.

All medication is to be given to the camp nurse to administer to the camper unless approved by camp
administration.

Medical Expense Liability (or by Parent/Guardian if under 18)*

I agree to the Medical Expense Consent below.

I understand that if any accident or sickness should occur, which the camp insurance does not
provide, the expense is my own responsibility and the camp will not be held liable for any expense in

Signature*

Date*

YYYY

Emergency Contact*

First Last

Phone*

Relationship*

Permission to use Photograph for The Church of God, NC - Family Camp

Yes

I grant to The Church of God, it's representatives the right to take photographs of me (or my child) and my property in connection with the above-identified subject. I authorize The Church of God, it's assigns and transferees to copyright, use, and publish the same in print and/or electronically.

Camp Tuition*

1 Person - $95.00

2 People - $180.00

3 People - $265.00

4 People - $350.00

5 People - $435.00

6 People - $520.00

CAMPER FAMILY PLAN (Cost reflects ages 6 and up) (family must live in same household) Choose the plan of the number in the household that is age 6 & up. For ages of 3-5, you will add $20 to family plan to cover food cost. Ages 2 & under - no cost. The SNACK SHACK will be open to purchase snacks/drinks. This is NOT included in the tuition. Snack Shack cards can be purchased in advance or at camp. ($5 per card) APPLICATION DEADLINE May 1, 2025 No applications after deadline unless extenuating circumstances occur.

Name for other members in your family plan.

Payment Options*

Today (Online)

In Person (At Checkin)

A deposit of $20.00 is required with this application for coverage of insurance while in-route to camp. T-Shirts must also be paid in advance to get one. You may cancel up to 1 week in advance and receive a refund. There are no refunds for T-Shirts.