Steps to register for camp
(Please Submit each of the following 3 forms below)
Please fill out and pay the camp registration or your child's spot wont be held

Cost for Retreat is $92

1. Fill out registration below (click pproceed to checkout to get registered)

Camp Registration

Camper info

Camper First name

Camper Last name

Camper Age

Camp Attending

Camper Grade

Camper Sex

First Time at Camp *

Yes

Birthdate

Parent/Guardian Info

Parent/Guardian Info 1

Parent First name

Parent Last name

Parent Phone Number

Parent Email

Relationship to Camper

Street Address

City

Region/State/Province

Postal / Zip code

Parent/Guardian Info 2

Parent First name

Parent Last name

Parent Phone Number

Relationship to Camper

Church info

(Leave blank if you do not attend church)

Youth Pastor/ Pastir First name

Youth Pastor/Pastor Last name

Church Name

Church Phone Number

Street Address

City

Region/State/Province

Postal / Zip code

Diet and Nutrition

Camper eats regular diet

Camper is a vegetarian/Vegan

Camper has special food needs

Camper has food allergies

Please list/describe all food allergies or special diets here

Camper Restrictions

Camper can participate in any and all activities

Camper can participate with the following restrictions or adaptations

Please list/describe all restrictions

Photo/Video Release

I hereby authorize Camp Suwannee to use pictures of my child/ward taken in a photograph, digital image, videotape, motion picture, and/or testimonial (written words). The undersigned hereby releases Camp Suwannee, its agents or employees, as well as any and all users and exhibitors of said pictures, from any and all claims, demands, accountings, and causes for which the aforesaid videotape, testimonial, motion picture, digital image, or photograph likeness may be used pursuant to this Consent and General Release. It is also my understanding that I will receive no compensation for my likeness or testimonial.

Photo/video permission *

Yes

I herby certify that to the best of my knowledge, the provided information is true and accurate

Your Signature

Select a date

There is a 3% charge so the cost is $92

Thanks for registering!

2. Emergency Contact

Emergency Contact Form

Camper Info

First name

Last name

CAMPER EMERGENCY CONTACT DETAILS:

Contact First Name

Contact Last Name

Contact Email

Relationship to Camper

Contact Phone Number

Physician First Name

Physician Last Name

Insurance Company

Policy Number

Physicians Phone

Insurance Address

List all medications required on a regular basis

Allergies/Physical Restrictions

Front of Insurance Card

Upload File

Upload supported file (Max 15MB)

Back of Insurance Card

Upload File

Upload supported file (Max 15MB)

Thanks for submitting!
We’ll contact this person only in case of emergency.

3. Medical Info./Medical release

Health Declaration

Please fill out the following form
in order to participate in our activity.

Camper first name

Camper last name

Contact Email

Back Problems *

Yes

Heart Disease *

Yes

Contacts/Glasses *

Yes

Convulsions/Seizures *

Yes

Diabetes *

Yes

Heart Murmur *

Yes

Hearing Impairment *

Yes

Diarrhea/constipation *

Yes

Had surgery *

Yes

High blood pressure *

Yes

Asthma *

Yes

ADD/ADHD *

Yes

Migraines *

Yes

Motion sickness *

Yes

Fainting or dizziness *

Yes

Nose bleeding *

Yes

Skin problems (rash, etc) *

Yes

Chronic or recurring illness *

Yes

Ear Infections *

Yes

Bed-wetting *

Yes

Recent injury,illness or infectious disease (in last 6 months) *

Yes

Joint Problems (knees, etc.) *

Yes

Cancer/leukemia *

Yes

Mononucleosis (in last 12 months) *

Yes

Emotional Disturbances *

Yes

Had a head Injury *

Yes

Been Hospitalized *

Yes

Sleepwalking *

Yes

Kidney disease *

Yes

Menstrual cramps *

Yes

Hemophilia/other bleeding disorder *

Yes

Other medical history not specified *

Yes

Traveld outside U.S (last 9 months) *

Yes

If you answered yes to any question, please elaborate

For travel outside U.S, name country(s) visited and dates

Mental, social and Emotional health (check yes or no)

Ever been treated for ADD or ADHD *

Yes

Takes ADD or ADHD medication during the school year that the camper does not/may not take during the summer *

Yes

Takes ADD or ADHD medication during the summer *

Yes

If you answered yes to any question, please elaborate

Ever been treted for behavioral, emotional, or eating disorder *

Yes

During the last 12 months, seen a professional to address mental/emotional concerns *

Yes

Had a significant life event, that continues to affect the campers life (death in family, abuse, adoption, foster care, etc.) *

Yes

Camper will take medication while at camp "Medication" is any substance a person takes to maintain and/or improve their health. This includes vitamins & natural remedies) *

Yes

Date of Last Physical

Immunization

Tetanus (DT, DTaP, Td, or Tdap)

Year primary series completed

Year of last booster

Tuberculin Test

Type

Year Last Given

Result

For Medical Treatment: I understand that the Camp Director for the week is serving as the guardian of my child while attending camp and has my permission and support to act on my behalf. By initialing below, I agree to hold the Florida Conference of Advent Christian Churches (FLCACC) or any employee or volunteers of said organization, harmless for any accidental injury to my child while participating in any and all camp programs. I also agree to hold them harmless if my child tests positive for COVID 19 after attending camp. I authorize the Camp Director for the week and/or weekly staff to consent to any and all x-rays, examinations, anesthetic, medical or surgical treatment and hospital care (including, but not limited to, intravenous solutions and/or blood transfusions), to be rendered to my child under general and specific supervision and of the advice of any physician or surgeon licensed to practice in the United States of America. I also agree to be financially responsible for any and all medical and/or surgical procedures rendered to my child. I understand that my child must undergo a health check by the Camp Nurse before registration, and if anything of concern is found, options will be discussed before being allowed to proceed to registration.

Medical Treatment agreement

***Florida law requires original pharmacy containers with labels which show the camper’s name and how the medication should be given. Provide enough of each medication to last the entire time the camper will be at camp. ***

I declare that the info I’ve provided is accurate & complete

Your Signature

Thanks for submitting!

What To Bring To Camp

What Not To Bring To Camp

✓ Bible, pencil and paper

✓ Bedding or sleeping bag & pillow
✓ Comfortable clothes and shoes for outdoor activities
✓ Toiletries and towels

✓ Swimsuit and towel (conservative, one piece)

✓ Flip flops/sandals/water shoes
✓ Dirty clothes bag

✓ Light jacket or sweatshirt
✓ Money for snacks and T-shirt, if desired
✓ Sun block and bug repellant

✓ Flashlight

✓ Reusable Water bottle

NO ELECTRONIC DEVICES (NO CELL PHONES)
Fireworks
Lighters or Knives
Weapons of any kind
Drugs, Alcohol, Tobacco, Vapes

Possession of alcohol, tobacco, vapes, or drugs of any kind will result in immediate dismissal and possibly exclusion from future events!!!

Steps to register for camp (Please Submit each of the following 3 forms below) Please fill out and pay the camp registration or your child's spot wont be held

Cost for Retreat is $92

1. Fill out registration below (click pproceed to checkout to get registered)

Camp Registration

Camper info

Parent/Guardian Info

Parent/Guardian Info 1

Parent/Guardian Info 2

Church info

Photo/Video Release

2. Emergency Contact

Emergency Contact Form

Camper Info

CAMPER EMERGENCY CONTACT DETAILS:

3. Medical Info./Medical release

Health Declaration

​

Mental, social and Emotional health (check yes or no)

Immunization

Tetanus (DT, DTaP, Td, or Tdap)

Tuberculin Test

What To Bring To Camp

What Not To Bring To Camp

Click here for financial assistance

Steps to register for camp
(Please Submit each of the following 3 forms below)
Please fill out and pay the camp registration or your child's spot wont be held