Name of Camper
* Name of Camper
Grade this Fall
Select the Grade level the Camper will be going into this Fall. (note: 0 for PreCampers, 14 for College Campers & 20 for Adult Campers)
0 - PreCamper
3 - Junior Camper
4 - Junior Camper
5 - Junior Camper
6 - Intermediate Camper
7 - Intermediate Camper
8 - Intermediate Camper
9 - Senior Camper
10 - Senior Camper
11 - Senior Camper
12 - Senior Camper
14 - College Camper
20 - Adult Camper
Campers Phone# if applicable
Parent Contact Number
* Parent Contact Number
Alternative Contact Phone Number
Emergency Contact Phone
* Emergency Contact Phone
Camper has been baptized
I give permission for my child to be baptized.
Please list any allergies the camper may have so that we can ensure a safe week for everyone.
Date of Last Tetanus or Booster
Medication Dosage Chart
Please list each medication, dosage, and the time it needs to be taken. (Breakfast, Lunch, Supper, Bedtime, Other)
I, the undersigned, give permission for my child to be given over-the-counter medications (non-prescription).
If you checked "No", please explain.
In the event that your child becomes ill, you will be notified. For his/her health, as well as for the health of the other campers and staff, and upon the advice of the Camp Nurse, the camp and parent together may decide it best for the parent to pick the child up early from camp. Camp administration holds the right to make the final decision.
Please list any recent surgery, injury, health or emotional condition that the camp staff should be aware of that might restrict your child from participation in camp activities. Please list the restricted activities, due to health reasons.
Please list: Family Insurance Company, Insurance Subscriber's Name, Insurance Claims Address, Policy #, ID #, and the Pre-Authorization Phone # if required.
I (and the camper) have read and agree to follow, the Dress Code and Rules and Disciplinary Policies provided by BHBC and understand that if my child must be expelled from camp early, all camp fees will be retained by BHBC and no refunds will be granted. These policies of Black Hills Bible Camp are available at the link at the bottom of this page.
In case of an emergency, I hereby give permission for a representative of Black Hills Bible Camp to seek necessary medical attention from qualified personnel and secure proper treatment for my child.
You are NOT yet registered!!! Please complete your registration by making your payment at the camp online payment page. Place your camper fee in your shopping cart & enter your T-Shirt size if you want to order a T-Shirt for camp. (Adults - please bring a camp chair)