Friendship Baptist Camp
2023 Registration/Medical Release
Camper Name __________________________________________________________ Phone #________________________
Home Address ______________________________________________________ Birthday ________________Age ________
City_______________________________________________________State ________________ Zip _________________
Email address: _____________________________ Parents' Names_______________________________________________
Church Name______________________________________ Church Address_______________________________________
Church Contact Person/Phone Number_______________________________________________________________________
Are you a Christian? _________Yes _________No Do you know how to swim? ________Yes ________No
ALL MEDICATIONS MUST BE TURNED IN TO THE DIRECTOR!
No medicine is allowed with children!
**You must leave written instructions with the director/counselor for ANY medications or allergies!
Include name of medication, specific dosing instructions (before/after meals, with food/drink, etc.)!**
Allergies?____________________________________________________________________________________________
Medications?_________________________________________________________________________________________
Other information:______________________________________________________________________________________
Emergency Telephone numbers:
Please list the name(s) and telephone numbers of relatives or friends who might be contacted in the event you can not be reached.
These people should be allowed to pick up your child from camp if necessary.
Name Phone # Relationship
_____________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________________________________________________
If my child should require medical attention and I am unable to be reached, I give permission for the camp director/manager to select a
physician and/or hospital for treatment. I also give my consent for the doctor and/or hospital to treat, order injections, anesthesia, or
surgery for ____________________________________ I further agree to assume responsibility for payment of services not covered
by my child's insurance.
Parent Signature ___________________________________________________
Preferred doctor ______________________________________ Hospital _____________________________________



Early Registration (By June 25th) - $150
After June 25th-$160
Mail to: P.O. Box 542
Winnfield, LA 71483
or PayPal
