This is an example headline Step 1 of 5 - Camper Information 20% Camper Name* First Last Camper Date of Birth* MM slash DD slash YYYY Camper Gender*MaleFemaleGrade in School for Fall 2023*Please enter a number from 2 to 12.Name of Home Church Parent or Guardian Name* First Last Parent or Guardian 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 Parent or Guardian Email* Enter Email Confirm Email Parent or Guardian Phone*Emergency Contact* First Last Emergency Contact Phone* Each camper must be immunized against the following, according to H.H.S. standards: polio, measles, mumps, rubella, diphtheria, tetanus, and whooping cough.Does the camper take any medication?*YesNoMedications taken regularly:*Reasons for taking medications:*Check here if medications sent with camper: Medications sent with camper Date of last tetanus shot: MM slash DD slash YYYY Does the camper suffer from any allergic reactions?*YesNo allergic reactionsThe camper suffers from the following reactions:* Bee Stings Penicillin Other Other reaction:* Type of allergic reaction:* Treatment given:* Is the camper restricted from any activity?YesNoRestricted activities:* Reason for restriction: Confirmation of Immunization*Each camper must be immunized against the following, according to H.H.S. standards: polio, measles, mumps, rubella, diphtheria, tetanus, and whooping cough.I confirm that the camper is immunized against polio, measles, mumps, rubella, diphtheria, tetanus, and whooping cough.Acknowledgement & Acceptance of terms*The camp nurse has my permission to care for the minor health needs of my child. In the case of a medical emergency, I understand every effort will be made to contact parents or guardians of campers. In the event that I cannot be reached, I hereby give my permission to the physician selected by the camp director/staff to hospitalize and secure proper treatment for, and order injection and anesthesia or surgery for my child as named above. Furthermore, I agree to hold harmless Benchmark Ministries, their officers, staff, counselors, sponsors, and workers associated with the camp, from any claim of loss, damage or injury associated with my child's participation in Camp, including transportation to and from the camp. I affirm that the medical information listed on this form is both correct and complete. Benchmark Ministries Inc. has my permission to use pictures, videos or interviews of my child to promote the cause of Christ and Benchmark Ministries Inc. I understand and accept the terms stated in this entire registration form.Acknowledgement & Acceptance of Dress Code by Parent/Guardian and Camper*All clothing must be modest, loose-fitting, and at least knee length. No tank tops, low neck lines, or midriff tops. Clothing must cover shoulders. No worldly or obscene pictures/words on clothing.I understand and accept the dress code. Please check one week* Teen Week 1 (June 13 - June 17, 2023) 7th - 12th Graders Junior Week 1 (June 20 - June 24, 2023) 3rd - 6th Graders Teen Week 2 (June 27 - July 1, 2023) 7th - 12th Graders Junior Week 2 (July 11 - July 15, 2023) 3rd - 6th Graders Teen Week 3 (July 18 - July 22, 2023) 7th - 12th Graders Junior Week 3 (July 25 - July 29, 2023) 3rd - 6th Graders Payment option:*$50 non-refundable deposit now with $200 balance (Early Bird Special)$50 non-refundable deposit now with $250 balance.$300 full amount now.I'd like to request sponsorship for my camper.Camp cost is $300 which includes meals, lodging, and activities. The $50 non-refundable deposit will be applied to the total camp cost. The $250 balance is due upon arrival the Tuesday morning of camp. Your camper(s) will need spending money for canteen /camp store to purchase snacks, drinks and souvenirs. Canteen/camp store is open twice daily. “Early Bird Special”: Registrations received before February 1, will receive a $50 discount. Sibling discounts are available upon request. Registrations will be accepted on a first come, first serve basis. Please contact Director Tom Lewis for more information: tomlewis@benchmarkministries.org or by phone at (919) 815-7603Camper Fee Sponsorship Request Camp Victory at Moore's Keep is committed to seeing that no child ever misses out on the blessings of the Christian camp experience due to the lack of funds for camper fees. We are also committed to be responsible, good stewards of that which God has blessed the ministry with and need to approve request on a case by case basis. Please fill out this camper sponsorship request in order that we may have the opportunity to line up your need with resources dedicated to sponsorships. You should receive an email within five days identifying the status of your request. Please contact Tom Lewis at 919-815-7603 for questions concerning sponsorship.Circumstance of sponsorship request:*Amount Requested* Remainder of fee after deposit is paid 100% of the camper fee including deposit Other Other:* Payment amount Price: Payment amount Price: Total $0.00 Credit CardPlease check if you have activated a Stripe feed for your form.