Oak Hill Christian Service Camp

Oak Hill Christian Service Camp
8451 Oak Hill Camp Drive
Mechanicsville, Virginia 23111
Phone (804) 779-3050

Registration & Medical Form

Name:

Address:

City/State/Zip:

Email Address:
Parent(s):

Phone:

(H)

(W)

(C)

Gender:	Age:	DOB (mm/dd/yy):	Grade This Fall:
M F

Ethnic Group:	Caucasian	African-American	Asian	Other
	Pacific Islander	Hispanic	Native American


Immersed: Yes No	Attended Oak Hill Before Yes No

Church I Attend: Member: Yes No
Week to Attend:

If my child accepts Christ and desires baptism and I cannot be reached for confirmation, my permission is : Granted Not Granted

Family Physician:
Address:
City/State/Zip:
Phone:

Please check if camper has had any of the following conditions:
Heart Trouble	Diabetes	Sleep Walking	Bed Wetting
Rheumatic Fever	Convulsions	Fainting	Asthma
Tuberculosis	Night Terror	Poison Oak	Poison Ivy
Other:

IMMUNIZATIONS:
DPT Series	Polio	Current Tetanus	Measles, Mumps, Rubella Series

If this camper takes medication (OTC or prescription), please attach a note indicating type of medication and dosage and/or any physical restrictions/limitations or known allergies.

I certify that the child named on this registration form is in good physical condition, with no organic weakness or problem which would make it unsafe for him/her to engage in an athletic program such as competitive games, running, hiking, and aquatic activities. Exception: (Please attached note.)

I also certifiy that the Camp Manager, Camp Dean, or Camp Nurse has my permission to sign any consent forms for needed medical aid or hospitalization.

Parent's Signature: ________________________________________________________________

Date: __________________________________________________________________________

I have read the Camp's Dress Code Policy and Code of Conduct located on the camp's website at www.oakhillcamp.org or in the brochure. I understand all rules and penalties and will abide by them.

Camper's Signature: ______________________________________________________________

Parent's Signature: _______________________________________________________________

Date: __________________________________________________________________________

Note: If somone other than the parent(s) / guardian(s) named on this form will be picking up this camper, please attach a note or notify the camp dean or manager, naming the person who will be picking up the camper. No child will be allowed to leave with an unauthorized person until contact can be made with a parent. Parents or other authorized drivers must sign out the camper with the Dean of the Week before leaving camp property. For your protection and the protection of your campers, please assist us in this area. The camp will not be responsible for those who leave without signing out first!

In accordance with Federal law and U.S. Department of Agriculture policy, this institution is
prohibited from discriminating on the basis of race, color, national origin, sex, age, or disability.


For Office Use Only
Date Rec'd:	________________	Amt. Paid By Camper:	_______________
Registration Fee:	________________	Camper's Check # / Cash:	_______________
Discount Applied:	________________	Amt. Paid by Church:	_______________
Materials Fee:	________________	Church Check #:	_______________
Canteen:	________________	Amt. Paid by Other:	_______________
Total Due:	________________	Other's Check #:	_______________
Total Paid Today:	________________
Amt. Due at Registration::	________________	Cabin Assignment:	_________________