Grade Just Completed ______Male / Female

CAMPER’S PERSONAL INFORMATION

Name ______Age______

Address ______

City ______State ______

Zip ______Phone ______

Email ______

Grade just completed ______Male / Female

T-SHIRT INFORMATION

You are not required to buy a t-shirt, but they are a great memento of your time at camp. The cost is $10 per t-shirt. This is in addition to the cost of camp and form must be returned by June 15th to ensure your size being ordered! Please circle your size if you are ordering. Thank you.

Youth - YS YM YL YXL

Adult - S M L XL 2XL 3XL

Make checks payable to

Skiatook Church of Christ

Please circle the amount you are paying:

Camp fee - $195 T-shirt - $10 Deposit - $100

The camp fee includes lodging, meals, canteen, and camper accident insurance.

MEDICAL INFORMATION

Any Allergic reactions? ______

Taking Medications? Yes/No How often? ______

What Kind? ______

Physical Limitations? ______

Name of Physician ______

Phone ______

Date of last Tetanus injection ______

Insurance Company ______

Policy Number ______

Policy Holder Name ______

Please provide a copy of insurance card for our records.

I hereby grant permission for the person named about to attend Burnt Cabin Christ Camp.

I give my permission for the Camp Director to authorize routine treatment of non-emergency care in cases of injury or illness. In any emergency, I understand that every reasonable effort will be made to contact me. In the event I am not reached promptly, I hereby give my permission to the physician selected by the camp director to hospitalize and secure proper treatment, including surgery, for my child at my expense to the extent not covered by the camper’s insurance. I release Burnt Cabin Christian Camp and all camp personnel from any liability arising from all routine or emergency care.

Parent or Legal Guardian ______

Date ______Phone ______Emergency Contact Name ______Emergency Contact Phone ______

The purpose and aim of Burnt Cabin Christian Camp is to create a space for spiritual training where youth have the opportunity to develop a deeper relationship with God. The camp offers activities to help youth gain knowledge and develop attitudes that will result in decisions to submit themselves to the Lord and live according to His teaching. We promote an appreciation for spiritual values and good morals, encourage a Christ-centered world-view and facilitate the forming of genuine Christian friendships.

Burnt Cabin Christian Camp is a non-profit organization and does not discriminate. The rules for participation are the same for everyone without regard to race, color, sex, age, national origin, or handicap. While the camp takes reasonable precautions, it is agreed that the camp assumes no responsibility for the camper’s personal property. All personal belongs should be clearly marked.

All events are conducted under adult supervision. A certified lifeguard will be present during swimming. Burnt Cabin has insurance that will cover the cost of treatment of bodily injuries not covered by or in the absence of other medical insurance on the camper. Illness is not covered under this insurance.

Camp phone numbers are 918-457-5209 or 918-457-4120.

Send Camper Mail to:

Burnt Cabin Christian Camp

C/0 (your child’s name)

17373 W 929th Road

Park Hill, OK 74451

What to Bring: Not to Bring:

Bedding for twin size bed Tobacco/Alcohol

Towels, Toiletries, Sunscreen Fireworks/Knives

Flashlight, Insect Spray Gum

Swimsuit & cover-up Miniskirts/ short-shorts

Bible & Notebook Midriff tops/Tank-tops

Modest clothing

Registration in 2:00 - 4:00 pm on Sunday, July 2nd.

Burnt Cabin

Christian Camp

July 2nd - 8th

Thin Spaces

Luke 17:21

Hosted by: Skiatook church of Christ

1900 W. Rogers Blvd.

Skiatook, Ok 74070

918-396-2647

Please return application to your local youth minister,

or mail to the above address.