Online Youth Registration Please read before filling out this formRegsitration Information: As of now, you are only able to register 1 camper at a time using our online system. We apologize for the inconvenience, but it helps keep your costs lower. There will be a 3% service fee for online registration. Registrations are not confirmed until deposit is submitted. Camp Information: Youth camps begin at 1 p.m. Campers will receive a free t-shirt for attending camp. Transportation: Camper registration fees do not include transportation fees. Transportation is available through your local Covenant Church. Please contact one of these Covenant churches to register for a bus to Bluewater: Baudette - 218-634-1827 Bemidji - 218-751-3699 Crookston - 218-281-2264 Grand Forks - 701-772-1884 International Falls - 218-283-3663 Kennedy - 218-674-4336 Lancaster - 218-762-7901 Roseau - 218-463-3420 Teien/ Drayton - 701-454-3353 Thief River Falls - 218-681-4449 Viking - 218-523-4735 Warren - 218-745-4191 Camper Name* First Last Parent/Guardian InformationParent/Guardian Email* Enter Email Confirm Email Parent/Guardian Name #1:* First Last Parent/Guardian Name #2: First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Parent Phone:*Parent Phone #2:Parent Phone #3:Camper InformationCamper Birthdate*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Camper Age*Please enter a value greater than or equal to 0.Camper Gender*MaleFemaleGrade Entering This Fall*3456789101112GraduateIf possible, I would like to be in a cabin with:**PLEASE LIST ONLY ONE PERSON.** One of the benefits of camp is to meet new people, plus the benefit of being with a friend in the cabin. Each camper will find out his/her cabin assignments upon arrival at camp. To be placed with a friend of your choice, both camper and friend must request each other as cabin buddies. Please sign up for no more than one cabin buddy. There is no guarantee that clusters of friends will be placed together in cabins because we deal with many circumstances: cabin size, number of counselors, number of campers of each gender, age, and more. Camp Attending*Scouts AScouts BTrailblazers ATrailblazers BExplorers AExplorers BNavigators ANavigators BHighlandersWhat amount will you pay now?*A $50 deposit is due with this registration. You may choose to pay in full now. If you choose to pay only the deposit, the remaining balance can be paid before, or upon arrival to camp. If you would like to pay an amount other than the options listed, please pay the deposit now and after completing the form you will be emailed a link to pay any amount. $50.00 (Deposit)$140.00 (Scouts Full Camp)$185.00 (Trailblazers Full Camp)$220.00 (Explorers, Navigators, Highlanders Full Camp)This is your Scouts Remaining BalanceYou can pay this balance before or upon arrival. This is your Trailblazers Remaining BalanceYou can pay this balance before or upon arrival. This is your Remaining BalanceYou can pay this balance before or upon arrival. Online Service Fee*There is a 3% fee for using our online registration system. Price: $0.00 Total $0.00 Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20182019202020212022202320242025202620272028202920302031203220332034203520362037 Expiration Date Security Code Cardholder Name Medical InformationPlease indicate if your child has any of the following health concerns:* None Asthma Diabetes Seizures Life Threatening Allergies Long Term Medication Mental Health Issues Please explain and/or describe care:Allow camp staff to give over the counter first aid*(For example, Tylenol, Sunscreen, Triple Antibiotic, Ibuprofen, etc.) YesNoActivity Restrictions, Special Needs, or Other Health Concerns:Medications being taken:***Please send medications in original bottle with detailed instructions.Immunization Record is current:*YesNoDietary RestrictionsHealth Insurance Company:*Insurance ID #:*Insurance Group #:*Emergency ContactEmergency Contact Name*Emergency Contact Phone*Relationship to Camper:Camper Contract I understand that every effort will be made to protect and safeguard all campers. I agree not to hold Bluewater Covenant Bible Camp liable for any illness or mishap from any cause whatsoever. I also give the Bluewater Covenant Bible Camp full authority in dealing with problems of discipline. I understand that any camper disregarding camp rules, is subject to being sent home with no refund of camp fees. I understand that any camper who willfully destroys property will be held responsible and charged accordingly. In case of emergency, if I cannot be contacted, I hereby give permission to the physician selected by the Camp Director to hospitalize, secure proper treatment for and to order injection, anesthesia or surgery for my child, as named above. I have disclosed to Bluewater Covenant Bible Camp all medical issues and medications that my child has or is using. I have read the brochure and will obey the rules of Bluewater Covenant Bible Camp. I give Bluewater Covenant Bible Camp permission to use comments, photos, and video of the camper named above in it’s promotional materials. I understand Bluewater Bible Camp cell phone policy. I agree to turn in my cell phone at time of registration. If not turned in and camp staff need to take away, I understand there will be a $25 fee to receive the phone back at the end of camp. I have read the brochure and will obey the rules of Bluewater Covenant Bible Camp. Signature of Parent/Guardian*Your typed name will count as your signature.Date*List current date Signature of Camper*Your typed name will count as your signature.Date*List current date PhoneThis field is for validation purposes and should be left unchanged.