Harvest Deaf Camp Registration – 2024 – Harvest Deaf Ministries

Harvest Deaf Camp 2024 (#8)

Camper Info

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Deaf or Hearing?

Date of Birth

Age

Name of church the camper is with

Parent/Guardian

Name of Parent/Guardian

Cell Phone

Emergency Contact Name

Emergency Contact Phone

Secondary Emergency Contact Name

Secondary Emergency Contact Phone

Health History

If food allergy, please list

If other allergy, or drug allergy, please list

Date of last tetanus

Date if booster

Date of DTP

Activities to be limited by physician's advice

List current medications and reason

Insurance Name

Group/Policy #

Physicians Name

Physician's Phone

I or my my child are not covered by insurance

My child may have swimmer's ear prevention drops after swimming if necessary

My child may have Tylenol for minor aches and pains

My child may have Ibuprofen for minor aches or pains.

Harvest Deaf Camp 2024 T-Shirts

Pre-order your camp shirt to have it ready for you when you arrive at camp! You will pay for your shirt when you check in at the registration table at camp.

Deadline to pre-order camp shirts is June 30th.

Adult T-Shirt Size

Youth T-Shirt Size

Photo/Video Release

I hereby grant Harvest Deaf Ministries the right to use any photographed and/or video image of my camper to edit such photograph and/or video in any manner it deems fit. I understand that the photograph and/or video image of me or my camper may be used for educational and promotional purposes of Harvest Deaf Ministries, and it is not being produced for profit. I hereby release HMD from any and all liability for claims and/or demands arising out of the agreement as set forth above. I will make no monetary or other claim against Harvest Deaf Ministries for the use of any photograph and/or video.

Yes, I give permisson

No, I do not give permission

Harvest Deaf Camp Registration - 2024

Registration Form:

Camper Info

Parent/Guardian

Health History

Harvest Deaf Camp 2024 T-Shirts

Photo/Video Release