• Register BEFORE July 1

  • Register BEFORE July 10

  • Register AFTER July 10

Camper Information


If camper is NOT to return home with parent, guardian or church, please indicate who is authorized to pick up your child at the conclusion of camp:

Medications: Please list any and all medications to be administered at camp.

Allergies: Please indicate all known allergies and suggested treatment/necessary medications (epi-pen, Benadryl, etc.).

Dietary Restrictions or Special Needs:

Please provide supporting documentation from a licensed health care provider.  Campers who do not provide supporting documentation will be required to provide food for their dietary needs.

Recent Injury/Serious Illness/ Physical/Personal Limitations:

Camper subject to: (please check all that apply) 

Insurance Information Name of Policy Holder

Emergency Contacts (in event parent/guardian can not be reached)

I hereby give consent for the camp nurse to dispense over the counter medication, such as, but not limited to, Acetaminophen, Ibuprofen, etc. to the camper named above. I also hereby authorized the release of all medical information to an attending physician in case of an emergency. In the event that I cannot be reached immediately, I hereby give permission to the camp staff to secure proper emergency medical care for illness or injury incurred during camp for camper named above.

Media Release
I hereby grant permission to the rights of my image, likeness and sound of my voice as recorded on audio or video tape without payment or any other consideration. I understand that my image may be edited, copied, exhibited, published or distributed and waive the right to inspect or approve the finished product wherein my likeness appears.

Photographic, audio or video recordings may be used for the following purposes:
conference presentations
educational presentations or courses
informational presentations
promotional videos

With my signature, I hereby validate this application form and do expressly waive any and all claims against the NCO District Church of the Nazarene and/or any of its Boards and/or any of its representatives, because of illness, injury, or damage to the person or property of the above names applicant in condition with, or incident to, the NCO Children’s Camp Program.

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