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WCCC Application 2023
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WCCC Application 2023
Locate Us
Downloads
Bulletin
Church Directory
Contact Us
WCCC Application 2023
Wayne County Christian April 20-23, 2023 ATTN Camper: Please fill the following form out along with your parent/guardian.
Please enable JavaScript in your browser to complete this form.
I am a:
Returning Camper
New Camper
Name
*
First
Last
Address
*
City
*
Zip
*
Phone
*
Parents Work Phone
*
Birthdate
*
Gender
*
Male
Female
Church You Attend
Do you have any physical handicaps?
*
Yes
No
If "Yes" to the previous question, please explain:
*
Answer "NA" if none
List any medications you must take:
*
Answer "NA" if none
List any allergies you have:
*
Answer "NA" if none
Do you have health insurance:
Yes
No
Insurance Co.
Answer "NA" if none
Insurance Co. Policy Holder
Answer "NA" if none
Insurance Co. Policy Number
Answer "NA" if none
Insurance Co. Policy Group Number
Answer "NA" if none
Please choose a t-shirt size:
Adult Small
Adult Medium
Adult Large
Adult XL
Adult XXL
CAMPER DISCLAIMER: I will abide by all camp rules, be a good sportsman, dress according to camp policy and exhibit a good Christian example at all times. I agree to follow the directives of the Wayne County Christian Camp directors and leaders at all times. I understand that failing to comply with the rules of this camp may result in my dismissal from camp and require my parent/guardian to make arrangements for my early departure.
*
By checking this box, as a camper you agree to the above Camper disclaimer.
PARENT/GUARDIAN DISCLAIMER: I, the undersigned parent or guardian, hereby consent to my child mentioned in this application, participating in the activities connected with Wayne County Christian Camp at Mid South Youth Camp in Henderson, Tennessee. I certify that my child is able to participate in all activities including sports and other camp related activities (unless indicated in the medical information on this application). I also give Wayne County Christian Camp permission for my child to be transported off the camp property to all camp-related activities. In case of accident or serious illness, Wayne County Christian Camp has my permission to secure the proper medical attention.
*
By checking this box, as the Parent/Guardian you agree to the above Parent/Guardian disclaimer.
Wayne County Christian Camp 2023
Price:
$ 30.00
Camp Fee
Website
Submit