Christian Wrangler Camp 2025

Sunday June 15th - Thursday June 19th

Camper Registration Form

REGISTRATION FORM MUST BE RECEIVED BY MAY 15TH

One form per child must be completed. Registration fee is $100 per child and must accompany this form. The registration form and fee should be mailed to Vicky Timmons, 915 E Hamilton, Wynne, AR 72396 or given to one of the CWC board members. Make checks payable to Christian Wrangler Camp. PLEASE DO NOT SEND CASH THROUGH THE MAIL. The age requirement to attend camp is 8 through 15 years old. For information, please contact Vicky Timmons at (870) 588-1648.

Registration fee includes a t-shirt for each camper. Please choose the size shirt your child will need.

Camper T-Shirt

IN ORDER TO KEEP THE CAMPERS FROM LOSING THEIR MONEY, ALL SNACK MONEY MUST BE TURNED IN AT REGISTRATION TO THE SNACK SHACK DIRECTOR. ANY MONEY THAT IS LEFT OVER WILL BE RETURNED TO THE CAMPER ON THE LAST DAY OF CAMP. THERE ARE NO EXCEPTIONS.

Individual Camper Information:

Camper First Name

Camper Last Name

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Gender

Birthdate

Parent/Guardian Phone Number

Emergency Contact

First Name

Last Name

Emergency Contact#

Medical Insurance Company

Policy Number

Group Number

Permission for Medical Treatment,
Photo, or Video

My permission is granted for the CWC Director, church official or any adult present or in charge of first aid to obtain necessary medical attention in case of sickness or injury to my child. Also, I understand that as a participant my child may be photographed or videotaped during normal camp activities and these photos/videos may be used in promotional materials. I, the undersigned, do herby verify that the above information is correct and I do hereby release and forever discharge all sponsors, the CWC Board and volunteers from any and all claims, demands actions, past, present, or future arising out of any damages or injury while participating a the Christian Wrangler Camp.

Signature of Parent/Guardian

Date

Medications/Medical History

ALL MEDICATION SHOULD BE BROUGHT IN AN INDIVIDUAL PILL ORGANIZER (AS SHOWN BELOW). MEDICATION THAT WILL NOT READILY FIT IN A PILL ORGANIZER MUST BE IN THE ORIGINAL PRESCRIPTION PACKAGING WITH THE CHILD’S NAME AND SHOULD NOT BE EXPIRED. THE CHILD’S NAME SHOULD BE ON THE BACK OF THE PILL ORGANIZER; EITHER ON A LABEL OR WRITTEN WITH A PERMANENT MARKER.

Medical History: (list any medical issues)

Current Medications (Dosage and times)

Allergies?

Yes

No

If Yes, please list below:

Allergies (Food)

Allergies (Medications)

Allergies (Insects)

Special Diet

Yes

No

If Yes, what are your camper's dietary requirements?

Current on Immunizations

Yes

No

May your child be given Tylenol if needed?

Yes

No

Previous Medical History or Conditions we need to know about