2020 LBBC CAMP REGISTRATION THEME: CAN YOU SEE… Note: Please comment at the bottom of page if you have any issues registering Parent/Guardian Name* First Last Parent/Guardian Primary Phone*Parent/Guardian Secondary PhoneParent/Guardian Email* Enter Email Confirm Email Please supply a valid email address for campers correspondence. A copy of this completed form will be sent ONLY to the PARENT/GUARDIAN email address for your records.My child(ren) and I have read the camp rules and confirm they will adhere to the dress code, swimming and all other guidelines set forth by Little Blue Bible Camp.* I agree to the statement above.I give consent to use photos of my child(ren) on Facebook, littlebluebiblecamp.org or other promotional material.*YesNoIs a parent/guardian a staff member for one of the camp sessions?* Yes-Session 1: July-12-19-Ethan Shull & Jarrod Williams, Co-Directors Yes-Session 2: July 19-24-JJ Shepherd, Director No How many boys are being registered?*01234If registering more than 4 CAMPERS please complete an additional registration form.How many girls are being registered?*01234 Camper #1: Name:* First Last Camper #1: Gender*Choose OptionMaleFemaleCamper #1: Age when session begins*Choose Option678910111213141516171819Camper #1: Camper Birth-date* Date Format: MM slash DD slash YYYY Camper #1: T-Shirt Size*Choose OptionYOUTH SMALLYOUTH MEDIUMYOUTH LARGESMALLMEDIUMLARGEXLXXLXXXLCamper #1: Has this camper received a scholarship?*YesNoCamper #1: Scholarship Code*Choose "Pay with cash/check" when selecting payment option Camper #1: How many camp sessions will this camper be attending?*One Session-------$135.00Two Sessions------$270.00Camper #1: Please check each session this camper will be attending.* Session 1: July 12-17-Ethan Shull & Jarrod Williams, Co-Directors Session 2: July 19-24-JJ Shepherd, Director Camper #1: Please select a payment option.*Pay online, full amount------$135.00Pay online, deposit only-----$20.00Pay with cash/check---------$0.00Camper #1: Please select a payment option.*Pay online, full amount------$270.00Pay online, deposit only-----$40.00Pay with cash/check---------$0.00MEDICAL INFORMATIONNote: Please turn in all medicines for the camper at check in-This includes both prescription and over the counter.Camper #1: Does this camper take any prescription or over-the-counter medications? Please list. Does this camper have any relevant health issues- including but not limited to allergies, chronic/recurring illnesses? Please List and Explain:*Note: Please turn in all medicines for the camper at check in-This includes both prescription and over the counter.Do you need to register a 2nd camper?*YesNo Camper #2: Name* First Last Camper #2: Gender*Choose OptionMaleFemaleCamper #2: Age when session begins*Choose Option678910111213141516171819Camper #2: Date of Birth* Date Format: MM slash DD slash YYYY Camper #2: T-Shirt Size*Choose OptionYOUTH SMALLYOUTH MEDIUMYOUTH LARGESMALLMEDIUMLARGEXLXXLXXXLCamper #2: Has this camper received a scholarship?*YesNoCamper #2: Scholarship Code*Choose "Pay with cash/check" when selecting payment option Camper #2: How many camp sessions will this camper be attending?*One Session-------$135.00Two Sessions------$270.00Camper #2-Please check each session this camper will be attending.* Session 1:-July 12-17-Ethan Shull & Jarrod Williams, Co-Directors Session 2: July 19-24-JJ Shepherd, Director Camper #2: Please select a payment option.*Pay online, full amount------$135.00Pay online, deposit only-----$20.00Pay with cash/check---------$0.00Camper #2: Please select a payment option.*Pay online, full amount------$270.00Pay online, deposit only-----$40.00Pay with cash/check---------$0.00MEDICAL INFORMATIONCamper #2: Does this camper take any prescription or over-the-counter medications? Please list. Does this camper have any relevant health issues- including but not limited to allergies, chronic/recurring illnesses? Please List and Explain:*Note: Please turn in all medicines for the camper at check in-This includes both prescription and over the counter.Do you need to register a 3rd camper?*YesNo Camper #3: Name* First Last Camper #3: Gender*Choose OptionMaleFemaleCamper #3: Age when session begins*Choose Option678910111213141516171819Camper #3: Date of Birth* Date Format: MM slash DD slash YYYY Camper #3: T-Shirt Size*Choose OptionYOUTH SMALLYOUTH MEDIUMYOUTH LARGESMALLMEDIUMLARGEXLXXLXXXLCamper #3: Has this camper received a scholarship?*YesNoCamper #3: Scholarship Code*Choose "Pay with cash/check" when selecting payment option Camper #3: How many camp sessions will this camper be attending?*One Session-------$135.00Two Sessions------$270.00Camper #3-Please check each session this camper will be attending.* Session 1:-July 12-17-Ethan Shull & Jarrod Williams, Co-Directors Session 2: July 19-24-JJ Shepherd, Director Camper #3: Please select a payment option.*Pay online, full amount------$135.00Pay online, deposit only-----$20.00Pay with cash/check---------$0.00Camper #3: Please select a payment option.*Pay online, full amount------$270.00Pay online, deposit only-----$40.00Pay with cash/check---------$0.00MEDICAL INFORMATIONCamper #3: Does this camper take any prescription or over-the-counter medications? Please list. Does this camper have any relevant health issues- including but not limited to allergies, chronic/recurring illnesses? Please List and Explain:*Note: Please turn in all medicines for the camper at check in-This includes both prescription and over the counter.Do you need to register a 4th camper?*YesNo Camper # 4 Name* First Last Camper #4: Gender*Choose OptionMaleFemaleCamper #4: Age when session begins*Choose Option678910111213141516171819Camper #4: Date of Birth* Date Format: MM slash DD slash YYYY Camper #4: T-Shirt Size*Choose OptionYOUTH SMALLYOUTH MEDIUMYOUTH LARGESMALLMEDIUMLARGEXLXXLXXXLCamper #4: Has this camper received a scholarship?*YesNoCamper #4: Scholarship Code*Choose "Pay with cash/check" when selecting payment option Camper #4: How many camp sessions will this camper be attending?*One Session-------$135.00Two Sessions------$270.00Camper #4-Please check each session this camper will be attending.* Session 1:-July 12-17-Ethan Shull & Jarrod Williams, Co-Directors Session 2: July 19-24-JJ Shepherd, Director Camper #4: Please select a payment option.*Pay online, full amount------$135.00Pay online, deposit only-----$20.00Pay with cash/check---------$0.00Camper #4: Please select a payment option.*Pay online, full amount------$270.00Pay online, deposit only-----$40.00Pay with cash/check---------$0.00MEDICAL INFORMATIONCamper #4: Does this camper take any prescription or over-the-counter medications? Please list. Does this camper have any relevant health issues- including but not limited to allergies, chronic/recurring illnesses? Please List and Explain:*Note: Please turn in all medicines for the camper at check in-This includes both prescription and over the counter.~~~If you need to register more than 4 campers please complete a second registration form. Thanks.~~~ Would you like to order additional LBBC t-shirts for yourself or other non-camper family members? Shirts cost $10 each ($12 for extended sizes)*YesNoRemember: Registered campers will receive one free t-shirt per camper per year.How many extra camp shirts you would like to order?*select one1234Shirt Size #1*selectSmallMediumLargeExtra LargeXXLXXXLXXXXLYouth SmallYouth MediumYouth LargeHow will you pay for this shirt?*Online todayCheck/cashHow will you pay for this shirt?*Online todayCheck/CashShirt Size #2*selectSmallMediumLargeExtra LargeXXLXXXLXXXXLYouth SmallYouth MediumYouth LargeHow will you pay for this shirt?*Online todayCheck/CashHow will you pay for this shirt?*Online todayCheck/CashShirt Size #3*selectSmallMediumLargeExtra LargeXXLXXXLXXXXLYouth SmallYouth MediumYouth LargeHow will you pay for this shirt?*Online todayCheck/CashHow will you pay for this shirt?*Online todayCheck/CashShirt Size #4*selectSmallMediumLargeExtra LargeXXLXXXLXXXXLYouth SmallYouth MediumYouth LargeHow will you pay for this shirt?*Online todayCheck/CashHow will you pay for this shirt?*Online todayCheck/CashPARENT/GUARDIAN CONSENT* I agree to the statement below.Your consent indicates you give your child(ren) permission to attend Little Blue Bible Camp and that you understand the the LBBC rules and expectations including the COVID 19 preventative measures being implemented by the LBBC Board. It also indicates that the information on this form is accurate to the best of your knowledge. You give LBBC staff permission to take your child(ren) to the nearest medical facility if an emergency arises.Registration is NOT CompleteNOTE: Registration is NOT complete. You must click "SUBMIT" below to complete the registration and submit your payment choice.Family Camp Total Price: $0.00 Today's Payment_ Price: $0.00 Today's Payment $0.00 Balance Due Before Check-In Price: $0.00 Staff Discount CodePlease note that the codes below are ONLY functional when paying in full and online otherwise your discount will be applied at check in.Enter your coupon code here. If you are a staff member for one or more sessions and are paying in full today please use the corresponding coupon code below.Assisting with 1 Session # of Kids Discount Coupon Code 1 $35.00 Staff41W1 2 $70.00 Staff41W2 3 $105.00 Staff41W3 4 $140.00 Staff41W4 Assisting with 2 Sessions # of Kids Discount Coupon Code 1 $70.00 Staff42W1 2 $140.00 Staff42W2 3 $210.00 Staff42W3 4 $280.00 Staff42W4 Note: PayPal is the only supported method of payment at this time.After clicking the submit button below you will be redirected to PayPal for payment processing. You do NOT need a PayPal account to submit payment. After you process your payment click on "Return to Merchant" to review the registration confirmation page.PhoneThis field is for validation purposes and should be left unchanged.
