Camper Registration Register for Camp – 2025 "*" indicates required fields Camper Name* First Last Parent Name* First Last Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Phone*Email* Camper Birthdate* MM slash DD slash YYYY Grade Completed*K123456789101112Gender* Girl Boy T-Shirt Size* Youth Medium 10-12 Youth Large 14-16 Adult Small Medium Large XL XXL XXXL Which camp would you like to attend?* Senior High Camp (June 18-23) Junior High Camp (June 26-30) Kid’s Camp 1 (July 6-10) Kid’s Camp 2 (July 13-17) Primary camp (July 20-22) Day Camp (July 19 ) First Time at Manna?* Yes No Cabin Mate Choice(s)Medical InfoEmergency Contact Name*Someone we can contact if you are unavailable.Emergency Contact Phone*Does the camper take medication? Either prescribed or or over-the-counter.* Yes No Please List any Medications… or type none if none.*When at camp, all medications/prescriptions must be in their original container with the pharmacy prescription label clearly visible. Medications will be made available to the camper by the camp’s health care provider unless other arrangements are made at registration by a parent or guardian. Tylenol, Ibuprofen, and other over the counter medications, if permitted, are available at the camp first aid station. Does the camper have any allergies?* Yes No Please List any allergies*Does this child get tetanus shots?* Yes, this child gets tetanus shots No, this child does NOT get tetanus shots Date of Last Tetanus Shot – (to the nearest year is ok) MM slash DD slash YYYY Please note: If no date is given and we are unable to contact you, a doctor may give this child a tetanus shot.Please list any limitations or special needs we should be aware ofCheck any that apply: Asthma Carries an Inhaler Bed Wetting Diabetic Heart Problems Heat Exhaustion Homesickness Sleepwalking Stomach Problems Sunburns Easily Special Diet Doctor's Name*Phone*Medical Insurance Provider*Policy Number*Medical Consent and Release* Check this box and sign the box below if you consent to the following:In the event of a medical emergency, and I cannot be reached during my child’s participation at Manna Resort, I give permission to the doctor selected by Manna Resort to secure treatment, hospitalize, perform surgery, and prescribe medications as deemed necessary to protect my child’s health and well-being. I also authorize Manna Resort to administer any medication, whether brought by the camper or available here (such as acetaminophen, ibuprofen, or other non-prescription drugs) as deemed advisable by the camp staff or a doctor, and to administer first aid when necessary. Further, in signing this form, I hereby certify that I give permission for my son or daughter to participate in the camping program of Manna Resort Christian Camp. I release Manna Resort, its agents, employees, or representatives from all claims or actions from the above named minor child participating in camp. My signature also gives permission for my child’s picture to be on our website or promotional material.Signature of Parent or Legal Guardian*Sign with a your computer’s mouse or touchscreen in the box.Pay in Full or Pay Deposit?* Pay in Full Pay Deposit Enter the amount you would like to pay now:*Balance (Bring this to camp with you)* Price: $0.00 Amount to charge: Payment MethodPayPal CheckoutCredit Card MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name NameThis field is for validation purposes and should be left unchanged.