Teen Camp 2017

Teen Camp 2017

Summer Camp Camper Application for Hope Haven Form Preview
Teen Camp 2017
  • Camp Hope Haven

    2017 Application- Teen Camp
  • Camper Information

  •  -  - Pick a Date
  • Parent/Guardian Information

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  • Camper Pick-Up Informtion

    Including yourself, List those who may be picking up your child on Friday at 3pm. We will only release the campers to the person(s) listed here. If plans change and information needs to be changed, please call us at 757-430-2235
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  • Emergency Contact Information

    In case we cannot reach you, list the person(s)we should contact to pick up your child in an emergency. DO NOT list yourself.
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  • Health Information

  • Allergy Information

    Please identify very specifically any allergies your child has (food, medications, animals, grass/pollen, etc.) and what the reaction is. If your child has a known allergy, you must send prescription or over-the-counter allergy medication, in its original packaging, with your child to camp.
  • Medications

    Please list all medications your child is currently taking. Failure to do so may prevent your child from attending camp. All prescriptions must be in original packaging, with your child's name and dosage on label. Bring only enough doses for the week. Medication will be dispensed in accordance with the doctor's prescription.
  • Photo and Video Release

  • I hereby grant the Union Mission Ministries the absolute and irrevocable right and permission to photography child and use his/her picture, silhouette or other likeness; to copyright same, to use and re-use the same in whole or in part, individually or in conjunction with other visual, audio or written material, in any medium for any purpose and to use and distribute any form of letter, media or publication of his/her story. I hereby release and discharge The Union Mission Ministries from any and all claims and demands. This authorization and release shall also insure to the benefits of the legal representatives, licenses and assigns of The Union Mission Ministries.
  • I have read the foregoing and fully understand the meaning and contents thereof.
  •  -  - Pick a Date
  • Consent to Attend (Important)

    I give permission for my child to attend Camp Hope Haven and will not hold The Union Mission or sponsors liable in case of sickness or accident.
  •  -  - Pick a Date


  • Credit Card Details
  • Should be Empty:
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