Camper Registration Summer Camp 2023 Please enable JavaScript in your browser to complete this form. - Step 1 of 5How many campers are your registering? *12345How would you like to pay? *I would like to pay only my deposit(s) todayI would like to pay in full todayNextCamper InformationCamper Name *FirstLastAge by Camp *Camper Birthdate *Camper Gender *MaleFemaleShirt Size - $15 (Free if registered by June 1) *Youth SmallYouth MediumYouth LargeYouth X-LargeX-SmallSmallMediumLargeX-LargeXX-LargeWeek Desired *July 5-7 – Discovery Camp (6-9yr) - $ 85.00July 9-14 – Junior Camp (8-12yr) - $ 235.00July 16-21 – Fusion Camp (8-14yr) - $ 235.00July 23-28 – Adventure Camp (10-13yr) - $ 235.00July 30 - August 4 – Teen Retreat (13-17yr) - $ 235.00Price listed includes early registration discountWeek Desired (with early registration discount) *July 5-7 – Discovery Camp (6-9yr) - $ 70.00July 9-14 – Junior Camp (8-12yr) - $ 200.00July 16-21 – Fusion Camp (8-14yr) - $ 200.00July 23-28 – Adventure Camp (10-13yr) - $ 200.00July 30 - August 4 – Teen Retreat (13-17yr) - $ 200.00Week Desired - Early registration discount will be applied after application is received *July 5-7 – Discovery Camp (6-9yr) - $85.00July 9-14 – Junior Camp (8-12yr) - $235.00July 16-21 – Fusion Camp (8-14yr) - $235.00July 23-28 – Adventure Camp (10-13yr) - $235.00July 30 - August 4 – Teen Retreat (13-17yr) - $235.00Does the camper have any known allergies or other medical conditions? *YesNoPlease explain:Has the camper been camping at Bliss before? *YesNoHow did you hear about Bliss Summit?Room Request2nd Camper Information2nd Camper - Name *FirstLast2nd Camper - Age by Camp *2nd Camper - Birthdate *2nd Camper - Gender *MaleFemale2nd Camper - Shirt Size - $15 (Free if registered by June 1) *Youth SmallYouth MediumYouth LargeYouth X-LargeX-SmallSmallMediumLargeX-LargeXX-Large2nd Camper - Week Desired *July 5-7 – Discovery Camp (6-9yr) - $ 85.00July 9-14 – Junior Camp (8-12yr) - $ 175.00July 16-21 – Fusion Camp (8-14yr) - $ 175.00July 23-28 – Adventure Camp (10-13yr) - $ 175.00July 30 - August 4 – Teen Retreat (13-17yr) - $ 175.002nd Camper - Week Desired *July 5-7 – Discovery Camp (6-9yr) - $85.00July 9-14 – Junior Camp (8-12yr) - $175.00July 16-21 – Fusion Camp (8-14yr) - $175.00July 23-28 – Adventure Camp (10-13yr) - $175.00July 30 - August 4 – Teen Retreat (13-17yr) - $175.002nd Camper - Does the camper have any known allergies or other medical conditions? *YesNoPlease explain:2nd Camper - Has the camper been camping at Bliss before? *YesNoHow did you hear about Bliss Summit?2nd Camper - Room Request3rd Camper Information3rd Camper - Name *FirstLast3rd Camper - Age by Camp *3rd Camper - Birthdate *3rd Camper - Gender *MaleFemale3rd Camper - Shirt Size - $15 (Free if registered by June 1) *Youth SmallYouth MediumYouth LargeX-SmallYouth X-LargeX-SmallSmallMediumLargeX-LargeXX-Large3rd Camper - Week Desired *July 5-7 – Discovery Camp (6-9yr) - $ 85.00July 9-14 – Junior Camp (8-12yr) - $ 175.00July 16-21 – Fusion Camp (8-14yr) - $ 175.00July 23-28 – Adventure Camp (10-13yr) - $ 175.00July 30 - August 4 – Teen Retreat (13-17yr) - $ 175.003rd Camper - Week Desired *July 5-7 – Discovery Camp (6-9yr) - $85.00July 9-14 – Junior Camp (8-12yr) - $175.00July 16-21 – Fusion Camp (8-14yr) - $175.00July 23-28 – Adventure Camp (10-13yr) - $175.00July 30 - August 4 – Teen Retreat (13-17yr) - $175.003rd Camper - Does the camper have any known allergies or other medical conditions? *YesNoPlease explain:3rd Camper - Has the camper been camping at Bliss before? *YesNoHow did you hear about Bliss Summit?3rd Camper - Room Request4th Camper Info4th Camper - Name *FirstLast4th Camper - Age by Camp *4th Camper - Birthdate *4th Camper - Gender *MaleFemale4th Camper - Shirt Size - $15 (Free if registered by June 1) *Youth SmallYouth MediumYouth LargeYouth X-LargeX-SmallSmallMediumLargeX-LargeXX-Large4th Camper - Week Desired *July 5-7 – Discovery Camp (6-9yr) - $ 85.00July 9-14 – Junior Camp (8-12yr) - $ 175.00July 16-21 – Fusion Camp (8-14yr) - $ 175.00July 23-28 – Adventure Camp (10-13yr) - $ 175.00July 30 - August 4 – Teen Retreat (13-17yr) - $ 175.004th Camper - Week Desired *July 5-7 – Discovery Camp (6-9yr) - $85.00July 9-14 – Junior Camp (8-12yr) - $175.00July 16-21 – Fusion Camp (8-14yr) - $175.00July 23-28 – Adventure Camp (10-13yr) - $175.00July 30 - August 4 – Teen Retreat (13-17yr) - $175.004th Camper - Does the camper have any known allergies or other medical conditions? *YesNoPlease explain:4th Camper - Has the camper been camping at Bliss before? *YesNoHow did you hear about Bliss Summit?4th Camper - Room Request5th Camper Information5th Camper - Name *FirstLast5th Camper - Age by Camp *5th Camper - Birthdate *5th Camper - Gender *MaleFemale5th Camper - Shirt Size - $15 (Free if registered by June 1) *Youth SmallYouth MediumYouth LargeYouth X-LargeX-SmallSmallMediumLargeX-LargeXX-Large5th Camper - Week Desired *July 5-7 – Discovery Camp (6-9yr) - $ 85.00July 9-14 – Junior Camp (8-12yr) - $ 175.00July 16-21 – Fusion Camp (8-14yr) - $ 175.00July 23-28 – Adventure Camp (10-13yr) - $ 175.00July 30 - August 4 – Teen Retreat (13-17yr) - $ 175.005th Camper - Week Desired *July 5-7 – Discovery Camp (6-9yr) - $85.00July 9-14 – Junior Camp (8-12yr) - $175.00July 16-21 – Fusion Camp (8-14yr) - $175.00July 23-28 – Adventure Camp (10-13yr) - $175.00July 30 - August 4 – Teen Retreat (13-17yr) - $175.005th Camper - Does the camper have any known allergies or other medical conditions? *YesNoPlease explain:5th Camper - Has the camper been camping at Bliss before? *YesNoHow did you hear about Bliss Summit?5th Camper - Room RequestPreviousNextEmergency Contact InformationPlease enter the name of the parent or guardian who should be contacted in the case of an emergency.Relationship *ParentSiblingRelativeFriendName *FirstLastEmail *Phone *Phone (2)AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeAdditional Comments or RequestsPreviousNextBliss Summit Health FormPlease fill out, sign, and return the Bliss Summit Health Form for each registered camper. The medical form must be signed by your doctor if you would like your child to receive medication while at camp. This is required for both prescription AND over the counter medications including bug spray and sunscreen. No doctor’s signature is needed if your child will not need any medication. You may either upload the completed documents below or click next and mail them in separately from this application.Completed Health Form Click or drag files to this area to upload. You can upload up to 5 files. PreviousNextParent AuthorizationThis Camper has my permission to participate in all camp activities, except as noted on the medical form. In the event I cannot be reached in an EMERGENCY, I hereby give permission to Bliss Summit Bible Camp to secure the proper treatment for my child, named above. I give Bliss Summit Bible Camp my permission to use photos and videos of my child engaging in normal camp activities for use in future camp promotions and publications.Date / Time *DateTimeFull Name *Clear SignatureTotal$ 0.00Square *CardName on CardSubmit