Author: Mia

Name________________________
Age______ Male or Female
Address:
____________________________
City_____________________
State_________ Zip___________
Phone
( _____)_____________________
(_____)_____________________
Emergency Contact :
Name & Phone
____________________________
(_____)_____________________
Roommate Request:
________________________
Week Attending:
July 6-10
Junior Week 1_______
July 13-17
Teen Week 1 ________
July 20-24
Teen Week 2 ________
July 27-31
Junior Week 2 ________
Fee: $100 for the Week
NO Discounts
This fee includes all meals and activities.
Bring Spending Money for
The Snack Shack and The Trading Post.
-Fill out the back of this form.-

Packing List
Shorts (Must come to the knee)
Shirts (No tank tops allowed)
Play clothes
Tennis shoes
Chapel clothes
Girls: Skirts/Blouses or Dresses (All to the knee)
Boys: Nice shirt & slacks
Swimwear:
Girls: One piece swimsuit
Boys: Trunks (T-shirt to the pool)
Sandals & Towel for Pool
Toiletries (Towels, Washclothes, Soap, Shampoo, Toothbrush, etc…)
Twin Sheets or Sleeping Bag & Pillow/ Flashlight
Bible, Pen, Notebook
Do NOT Bring:
Electronics, Cellphones, Tobacco, Fireworks, Music, Weapons, Immodest Clothing, Bad Attitudes

Camp Evangel
Mailing Address:
238 West Southland Drive
Ashland, KY 41102
Physical Address:
105 Camp Evangel Road
Pounding Mill, VA 24637
Website:
http://www.campevangel.org
Contact numbers :
606-928-5127 (SBI)
606-923-8599 (Arnold Adams)
276-964-2230 (Camp Evangel)

Camper’s Insurance Co. & Policy #
____________________________
____________________________
Name of Policy Holder
____________________________
Date of Last Tetanus Shot:
_______________________
Please list medication taken regularly, allergies, dietary needs or other pre-existing medical conditions on separate paper.
In signing this application I hereby certify that the person named on this form is in good health, and may participate in the activities of Camp Evangel. (Exceptions are listed on attached sheet.) In case of medical emergency, I authorize Camp Evangel officials to secure medical treatment that includes injection, anesthesia, surgery, or dental treatment for the camper named on this form. I agree the camper will abide by Camp Evangel rules of conduct and use of camp property; and will participate fully in the camp program. If Camp Evangel officials deem it necessary for him/her to return home because of illness or any other reason, I will abide by the Camp’s decision and make arrangements to bring him/her home. I give permission to use photos including the camper for publicity. I/we understand the possibility of unforeseen accidents and incidents; agree not to hold Camp Evangel/SBI, its leaders, staff, and volunteers liable for damages, losses, disease, or injuries incurred by the subject.
Parent/Guardian Signature:
________________________________________