The Week of Camp I Wish To Attend_______________________________________ Camper Name_________________________________________________________ Address__________________________City___________State_____Zip__________ Age of Camper_________________Grade completed as of June 1, 2002___________ Phone____________________T-Shirt Size:   10-12   14-16   A-S    A-M    A-L    A-XL Church________________________________City__________________State______ Parent's Name_________________________________________________________ Business Phone___________________________Cell/Beeper____________________ Email ________________________________________________________________ In Case of Emergencies, Call______________________________________________ Please List any physical limitations, allergies, medications, or other medical problems that might require special attention______________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Is camper a swimmer?      YES     NO     Camper has permission to swim?    YES    NO One person that camper would like to room with that is about the same age: ______________________________________________________________________ Other Comments ________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Enclosed is    _________$25.00 Non-refundable deposit   -OR-                       _________$100.00 Children's Camp or Girls Week Camp Fee                       _________$125.00 Middle or High School Week Camp Fee                       _________$160.00 Adventure Camp Fee or Sports Camp Fee                       _________$75.00 Day Camp Fee                       *** Please send either the entire camp fee or the $25.00 deposit. If you send the deposit now, you will owe the balance of the camp fees on the first day of camp. Parental Consent Form ____________________________has my consent to attend the Flint River Baptist Camp. It is my understanding that the Flint River Baptist Camp will notify me in the event of any emergency such as would seem to require a physician's attention. In the event that I cannot be reached, the physician/medical facility has my permission to treat my child. I do not hold the Flint River Baptist Camp, or any of its agents or representatives responsible for the health and safety of my child while on the premises. I further certify that to my knowledge, my child has not been exposed to any contagious diseases within the last thirty days. I have read carefully and agree to the above conditions. _______________________________      _________________     ________________        Signature of Parent/Guardian                           Date                               Phone

Please print this application, fill it out and mail it with your $25.00 deposit or payment to: Flint River Baptist Camp, 600 Baptist Camp Road, Griffin, Georgia 30223