Kootenai Christian Service Camp
Where Christ and a good time go together!
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REGISTER FOR CAMP
(Required fields are marked with *)
Select a Camp*
Camper Information
(Or enter primary contact person for Family Camp registration)
First Name*
Last Name*
   
Entering Grade
Age
Gender
 
Address*

Address 2
City*
State/Province*
Zip/Postal Code*
Camper Phone*
Camper Email
 
Home Church
Member?
 

Parent/Legal Guardian Information (required for campers under 18)
First Name*
Last Name*
 
Address*

Address 2
City*
State/Province*
Zip/Postal Code*
Primary Contact Number*
Secondary Contact Number
Email

FOR FAMILY CAMP ONLY
Number in your group (probable)


Limited cabin space is available on a first-come, first-serve basis. 

Will you need housing accommodations? (Select one)
  Will need housing
  Will bring tent or RV

How many tents will you bring?


How many campers/RV's?

MEDICAL RELEASE
Please indicate if the camper has a medical history in any of the following conditions (for 18 and over, please fill out for self - Do not fill out if registering for family camp):
  Drug Allergies
  Food Allergies
  Other Allergies
  Insect bites or stings
  Heart disease/condition
  Asthma
  Seizure disorder
  Diabetes
  Behavior Disorder
  Physical handicap
  Stomach problems
  Other (specify below)
Please give details for any checked above.  Include
normal treatment of allergic reactions.


Please list all medications the camper will be bringing to
camp, along with dosages and frequency of use. This
includes over-the-counter medications of any kind as
well as asthma inhalers.


Please list any activity-related restrictions that apply
to the camper.


Please list your insurance provider and policy number.
If you prefer, leave this field blank and enter the
information on the parental consent form instead.


Date of last tetanus shot, if known (MM/DD/YYYY)


Please enter any additional information that we should
know in order to make your camper's experience as
safe and positive as it can be.


In the event I cannot be reached in an emergency during
my child’s attendance at camp, I hereby give my
permission to the physician or dentist selected by
Kootenai Christian Camp to do what he/she deems to be
best and absolutely necessary for my child until such
time as I can be reached.  I will download, print, fill out,
and submit a signed release form along with payment for
camp. (Click here to download PDF form.  A link will also
be provided on the registration confirmation page.)
  Yes
  No

Emergency Contact Number (required for youth camps)


Please verify that an actual person filled out
this form by answering the following simple
question:
Summer can be hot.
Enter in the box what winter is (opposite of "hot").*