MEDICAL INFORMATION
List any Allergies ________________________________________________
Taking Medication? YES|NO How Often?____________________________
Note for sending medications to camp: Please send medications in original bottles
or write down all the information from the bottle on a separate piece of paper.
We are blessed to have a registered nurse and she needs to know what drugs
she’s dispensing, the dosage, and times to give the medication(s).
Our Logo
Name of Physician:______________________________________________
Physician’s Phone: _______________________________________________
Date of Last Tetanus injection:_____________________________________
Insurance Company:____________________________________________
Policy Number:_________________________________________________
Policy Holder Name:____________________________________________
Insurance Phone:_______________________________________________
Burnt Cabin Christian Camp
(Please provide a copy of insurance card for our records, thank you.)
I hereby grant permission for the person named above to attend Burnt Cabin
2015 Central Church of Christ
Christian Camp. I give my permission for the Camp Director to authorize routine
Camper Application
treatment of non-emergency care in cases of injury or illness. In any emergency, I
understand that every reasonable effort will be made to contact me. In the event I
am not reached promptly, I hereby give my permission to the physician selected
by the Camp Director to hospitalize and secure proper treatment,
including
surgery, for my child at my expense to the extent not covered by the camper’s
insurance. I release Burnt Cabin Christian Camp and all camp personnel from
any liability arising from all routine or emergency care.
JUNE 14th -20th
Director, Jimmy Hyde
405-273-3065, [email protected]
Parent or Legal Guardian ____________________Date_________________
Mail applications to:
Home Phone_____________________ Work Phone_____________________
Emergency Contact: ___________________________________________________
N a me a n d P h o n e n umb e r
Central Church of Christ
PO Box 1228
Shawnee, OK 74802-1228
Important Information
Join us for a week of learning God’s word, making new
friends, and growing closer to
God. We also have a ton of
fun with all types of games,
sports, swimming, and
canteen.
YOU’RE INVITED
Burnt Cabin Christian
Camp admits children of any
race, color, or national and
ethnic origin to all rights,
privileges, programs, and
activities generally available
to campers. Rules of
acceptance and participation
in the program are the same
for everyone. Our session is
for ages 9 through 18.
COST OF CAMP
The basic cost for a
week of camp is $180.00
per full week camper. This
fee includes canteen
(drinks and snacks), and
helps pay for lodging,
meals, daily swimming, and
camper
accident
insurance.
CAMP PHONE NUMBERS
FOR EMERGENCIES ONLY:
(918) 457-5209
(918) 457-4120
SAFETY FIRST
Burnt Cabin Christian
Camp conducts all events
under the supervision of
adults with the safety of our
campers in mind. A certified
lifeguard is present during
swimming. When accidents
or illness occur, the camper
will be attended by a
registered nurse. If needed,
a hospital is nearby. Burnt
Cabin carries insurance
which will cover the cost of
treatment of bodily injuries
not covered by or in the
absence of other medical
insurance on the camper
(illness is not covered).
PHONE CALLS
Campers calling home is
only allowed in emergency
situations.
GENERAL INFORMATION
There is room for 200
campers per session. ALL
SPACES ARE FILLED IN THE
ORDER APPLICATIONS ARE
RECEIVED. Fill out the application and medical forms
and mail with your deposit
to the address on the front,
not to the camp address.
DRESS CODE
No short shorts, must be 2
inches above the knee
No spandex, leggings, or
jeggings.
Burnt Cabin Christian Camp,
(Name of your child)
17373 W 929th Road,
Park Hill, OK 74451
Keep this portion.
Male or Female
spaghetti straps.
Name_______________________________________________________________
button, or cleavage.
Modest, one-piece swim-
Address______________________________________________________________
suits with a cover up for
traveling to and from the
pool area.
City__________________ State__________________
Zip__________________ Phone__________________
No clothing with worldly
messages
Last School Grade______ Baptized? YES | NO
Flip flops are welcome but
Church Affiliation?__________________________________________________________
must wear shoes during
games and sport times.
2. T-SHIRTS
WHAT NOT TO BRING
CELL PHONES
Valuables— Electronics like
Mp3 players
Knives
Fireworks
Tobacco
Pornographic materials
Alcohol
WHAT TO BRING
 Bible
 Bedding for twin size
Birth Date_______________________
Age_______________________
No clothing that shows belly
bunk or sleeping bag
SEND CAMPER MAIL TO:
1. PERSONAL INFORMATION
No muscle shirts
No tank tops, halter tops, or
You are not required to buy a T-shirt, but it is a great way to remember your time
Cut Here
BURNT CABIN CHISTIAN CAMP
at camp. The cost is $10 per T-shirt; please order by June 2. Any T-shirt order
after this date will be given out on a first-come, first-served basis. Add the total
cost of the T-shirts to your camper fees below and write one check to Central
Church of Christ.
Write the number of T-shirts you’d like to purchase in the blanks below.
YOUTH
YS___ YM___ YL___
ADULT
S___ M___ L___ XL___ 2XL___ 3XL___
 Flashlight
 Insect repellant
 Sunscreen
NUMBER OF SHIRTS____X$10 = __________
PREPARING FOR CAMP
Registration is from 2:00
- 4:00 p.m. on Sunday
afternoon.
I’m paying the: Full Amount
3. PAYMENT (Make checks payable to: Central Church of Christ)
$180
Deposit $80
Cost of T-shirts $________For a GRAND TOTAL of $_____________
Mail this portion.