Registration -

Download Registration to print whether it is printed or digital (form below) each individual attending should have a registration form. example: A father and one son should have 2 packets/forms . A father and 2 sons should have 3 packets/forms

Registration payments are as follows:

$75.00 for 1 person (Qty. of 1)

$150.00 for a Father and 1 son (Qty. of 2)

$225.00 for a Father and 2 sons (Qty. of 3)

And so on

Campout Registration Form

Full Name *
Date Of Camp Out *Please Enter the Dates you wll be attending (Example: 10-12 Noveber 2023

Campers Information

Age *
Address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Home Phone
Cell Phone
Work Phone
Email

Emergency Contact Information

Name *
Address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Relationship
Home Phone *
Cell Phone
Work Phone
Email

Special Needs Infornation

Does your child have an individual aide at school? *
YesNo
If so, will an aide be attending camp? *
YesNo
Does your child take any medications for a professionally identified medical or behavioral special need? *
YesNo
Allergies i.e. food allergies or bee stings *
YesNo
If yes, will an EpiPen be required? *
YesNo
Have you been under a doctors care in the last 6 monthts (if Yess please explain on rear of form. *
YesNo
Seizures / Epilepsy *
YesNo
Diabetes (If Yes Type I or Type II) *
YesNo
Will Medications need to be administered during camp hours ?s *
YesNo
List of Medications *
Medical Insurance Carrier *
Group # *
Identification Number *
Physician's name or source of medical care *
Physician's Phone #

Camp Release

I (we) agree that the individual and/or as parents /guardian of the individual on this form participates in all camp out activities at there own risk *
YesNo
I give permission for the "Get Connected " staff to transport my child to program activities *
yesno
I give permission for " Get Connected " to use any photos or videos of my child during the camp out for promotional purposes of "Get Connected" *
YesNo
I give permission for the "Get Connected" staff to apply sunscreen that I have provided *
YesNo
Is there a custody order (if Yes please provide a cop) *
YesNo
I (we) understand and agree that "Get Connected " staff does not assume any responsibility for accidents and / or medical or dental expenses expenses incurred as a result of participation in the camp out *
YesNio
I (we) undetsand and agree that all monies are nonrefundable after 1 November *
YesNo
I (We) authorize the leaders of this event on my/our behalf and at my/our account, to take such measures and arrange for such medical treatment by licensed physicians and/or hospitals, for the well being of the participant without further consent. *
yesNo
I (We) on our behalf hereby release, discharge, indemnify "Get Connected" Harker Heights, TX it's directors, officers, employees, physicians, agents and all volunteer personnel from all liabilities for damage, injury ,illness to above participant/property *
YesNo
I (we) understand that by clicking submit that you agree to all the terms and conditions and that all of the information is tru and correct *
YesNo

Please enter any two digits *Example: 12
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Registration Payment

Registration

Campout Registration Form

Campers Information

Emergency Contact Information

Special Needs Infornation

Camp Release

Plan Your Visit