Youth Registration Form Camp Registration "*" indicates required fields Please read before filling out this formRegsitration Information: 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. and camper pick-up is between 12:00-1:00 on the last day of camp. 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 - 218-281-1107 Grand Forks - 701-772-1884 International Falls - 218-283-3663 Kennedy - 218-674-4336 Lancaster - 218-762-7901 Roseau - 218-463-3420 Teien/ Drayton - 701-520-1033 Thief River Falls - 218-681-4449 Viking - 218-523-4735 Warren - 218-745-4191*Important Note - Please Read*Upon submission, if you are not redirected to a Confirmation Page, it means the submission did not work (look for any fields that may be highlighted in red) or contact us. Please watch your inbox or spam folder for a confirmation email from email@example.com. If you do not receive a confirmation email in the next hour, please let us know as it may mean your registration did not go through.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:Which local Covenant Church is closest to you?*Each local Covenant church has a Camp Coordinator who can be your point person for just about any question about Bluewater - especially dealing with busing and payments. Please select a church from the list, or click "None" if you do not live close to any of these areas. Note*** If you plan to ride the bus/van to camp, you need to select one of these churches. Baudette Bemidji Crookston Drayton Grand Forks International Falls Kennedy Lancaster Roseau Thief River Falls Warren Viking None Camper InformationCamper Birthdate*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Camper Age*Whole numbers only please, no decimals or fractions 🙂 Camper Gender* Male Female Grade Entering This Fall*Please Select3456789101112GraduateIf 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***Trailblazers B is now on a waitlist. There is still lots of room available in Trailblazers A. Scouts A Scouts B Trailblazers A Trailblazers B Explorers A Explorers B Navigators A Navigators B Highlanders What amount will you pay now?*A $50 non-refundable 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 - Non-refundable) $160.00 (Scouts Full Camp Price) $205.00 (Trailblazers Full Camp Price) $240.00 (Explorers, Navigators, Highlanders Full Camp Price) This is your Scouts Remaining BalanceThis is your Trailblazers Remaining BalanceThis is your Remaining BalanceOnline Service Fee*There is a 3% fee for using our online registration system. Price: $0.00 Total Credit Card*Card Details 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.) Yes No Activity Restrictions, Special Needs, or Other Health Concerns:Medications being taken:***Please send medications in original bottle with detailed instructions.Immunization Record is current:* Yes No Dietary RestrictionsHealth Insurance Company:* Insurance ID #:* Insurance Group #:* Emergency ContactEmergency Contact Name* Emergency Contact Phone*Relationship to Camper: TransportationBus or Van transportation departs from 3 locations: 1) International Falls 2) Roseau (stopping in Baudette), 3) Red River Valley - Starts at Michael Larson Farms, Stephen, MN - stopping in Grand Forks and Crookston and Bemidji if there is room.Do you plan to ride the bus/van to camp?* Yes No, I will provide my own transportation Which bus/van will you take? International Falls Roseau (can stop in Baudette) Red River Valley (Starts in Stephen, heads to Grand Forks, then over to Crookston, and Bemidji if there is room.) Where will you get on the bus? Larson Farms (Rural Stephen) Grand Forks (Home of Economy parking lot) Crookston (Ampride Cenex Station) Bemidji Covenant Church 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 MM slash DD slash YYYY Signature of Camper*Your typed name will count as your signature. Date*List current date MM slash DD slash YYYY **Before You Submit** - IMPORTANT!If you are not redirected to a Confirmation Page, it means the submission did not work (look for any fields that may be highlighted in red) or contact us. Please watch your inbox or spam folder for a confirmation email from firstname.lastname@example.org. If you do not receive a confirmation email in the next hour, please let us know as it may mean your registration did not go through. NameThis field is for validation purposes and should be left unchanged.