SOCC 2026

SOCC Camper Registration

Camper's Name

First Time Camper?

Yes No

Birth Date

Gender

Male Female

Home Address

Parent/Guardian Name

Parent/Guardian Email

This address will receive a confirmation email

Parent/Guardian Phone

Secondary Phone

(optional) Please list any other campers your child would like to room with:

(optional) Church you attend:

Shirt Size

Medical Information

Please select any of the following your child is subject to:

Diabetes Asthma Hay Fever Seizures/Epilepsy Fainting None

Please list any and all ALLERGIES (including foods), and any special dietary needs:

Does the camper have any restricted activities?

Yes No

If you answered yes, please list below

Is the camper currently under a physician's care for any acute/chronic medical conditions?

Yes No

If you answered yes, please list below

Are there any physical, emotional, medical, or psychological needs that require special attention?

Yes No

If you answered yes, please list below

Please list any current medications (including dosages) being brought to camp:

Physician Name:

Physician Phone:

Insurance Provider:

Insurance Policy Number:

Emergency Medical Contact (other than parents)

Emergency Medical Contact Phone

Liability Waiver/Permission

Every activity is sponsored by Southern Oregon Christian Camp/West Main Church of Christ (SOCC/WMCC) and is carefully planned and adequately staffed. However, even with the best planning and precautions, unforeseen events can occur. By signing this form, the parent or Guardian agrees to assume and accept all risks and hazards inherent in activities sponsored by SOCC/WMCC. These activities include, but are not limited to: swimming, boating, archery, and court sports. The parent or guardian also agrees not to hold this organization or its employees or volunteers liable for damages, losses, or injuries to the person named on this form.

Media Release: I grant permission to SOCC/WMCC for the right to use, reproduce, and/or distribute any photographs, videos, and sound recordings of me and my child without compensation or approval rights, for use in materials created for purposes of promoting the future activities of SOCC/WMCC.

Agree Disagree

Behavioral Issues: I understand that illegal, immoral, or inappropriate activities (i.e. use of drugs, vape pens, possession of weapons and or alcohol, fighting, stealing, etc,) may result in the named participant being sent home at the expense of the parent or guardian.

Agree Disagree

Medical Release: I hereby give permission to the medical personnel selected by the camp director to provide routine healthcare; to administer medications; to order x-rays routine tests, and or treatment; to release any records necessary for insurance purposes; and to provide or arrange related transportation for my child in the event I cannot be reached in an emergency. I hereby give permission to the physician selected by the camp director to secure and administer treatment, including hospitalization, for the registered camper.

Agree Disagree

SOCC 2026

Description

Please Fix the Following