COMBO 3 REGISTRATION

COMBO 3 REGISTRATION

JULY 7-11, 2025
Camper Information
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Age*
Grade in September*
I am a...*

Junior Camper (4th-6th Grade) (Pastor Derek Dewey)Teen Camper (7th-12th Grade) (Pastor Nathan Birt)
Gender*

MaleFemale
Does the camper have a phone number or email?

YesNoI don't know
Camper Phone Number (if applicable)
Please enter a valid phone number.
Camper Email (if applicable)
example@example.com
Home Address*

Address

Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Information
Name*

FirstLast
Relationship to Camper*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address*

Address

Address Line 2

CityState / Province

Postal / Zip Code
Employer*
Work Phone Number*
Please enter a valid phone number.
Email
example@example.com
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Church Information
Home Church Name
Pastor

FirstLast
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Church I'm Coming With (if different)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Insurance Information
Medical Insurance Company
Policy Number
Group Number
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact
Name*

First NameLast Name
Relationship to Camper*
Phone Number*
Please enter a valid phone number.
Email
example@example.com
Address

Address

Address Line 2

CityState / Province

Postal / Zip Code

Authorized Person to Pick up Camper

(Authorized people can be parents/guardians or any one else the parents/guardians authorize to pick up their campers. Please include the church if they will be taking your child home. If there is more than one person, please list all options in the additional information section.)
Authorized People*

Just parentsChurchSomeone other than above options
Name

First NameLast Name
Name of Church
Person Responsible
Relationship to Camper
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address

Address

Address Line 2

CityState / Province

Postal / Zip Code
Any additional information concerning authorized/unauthorized people for camper pick up:

Medical History
List any communicable diseases the camper has had: (such as hepatitis, measles, mumps, meningitis, diphtheria, rubella, salmonella, tuberculosis, giardia, or shigella)*
List any serious illnesses the camper has had: (such as Diabetes, Asthma, Mononucleosis, Epstein-Barr Virus, RSV, Leukemia, Juvenile Rheumatoid Arthritis, Cytomegalovirus, other)*
List any surgical operations the camper has had:*
List any known drug reactions and/or allergies for this camper:*
Will your child be bringing any medication with them to camp?*

YesNo
ANY MEDICATIONS TO BE TAKEN AT CAMP MUST BE IN THE ORIGINAL CONTAINER, AND ALL MEDICATIONS (OTHER THAN TYLENOL, ADVIL, AND CLARITIN) MUST COME WITH THE DOCTOR'S INSTRUCTIONS IN ORDER FOR THE NURSE TO BE ABLE TO ADMINISTER THE MEDICINE TO THE CAMPER. (Please reference frequently asked questions [for parents] on our website for more instructions about bringing prescribed medications.)

Understand and agreeDisagree
Please list all medications currently being taken by the camper:
Specify any special diet the camper will be on at the time of admission to TMBC:*
Please list any activity exceptions:*
If there is a need to update any of these fields (i.e., diet, medication being taken, or activity exceptions) after you have submitted your registration, please let the camp know by emailing office.tmbc@gmail.com. Thank you!
Primary Doctor/Office
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Sunscreen Permission
I give my permission for the staff at Treasure Mountain Bible Camp to assist with applying or to apply sunscreen to my child's exposed skin including the face, tops of ears and bare shoulders, arms, legs and feet 30 minutes before outdoor activities. It is my responsibility to provide sunscreen with a minimum SPF of 15. I understand I must provide the sunscreen in its original container labeled with my child’s name and within the noted expiration date. Sunscreen will not be applied to any broken skin or if a skin reaction has been observed. Any skin reaction observed by staff will be reported promptly to the parent/guardian.
Special Instructions
Parent/Guardian Signature*

Clear
Date

MonthDayYear
Date

General Release Form
I hereby give permission for my child to attend and participate in all of Treasure Mountain Bible Camp’s activities on/off the camp property. I hereby absolve Treasure Mountain Bible Camp from liability to me or my child because of an injury received while attending camp at Treasure Mountain Bible Camp. In case of any accident or serious illness, I hereby authorize Treasure Mountain Bible Camp to call upon a physician of their choice and to follow their instructions. If emergency treatment or hospitalization is required, I request Treasure Mountain Bible Camp to notify me. I also understand, if my child is sent home for any reason, there will be no refund. I also understand that my camper’s picture or testimony may be used in the promotion of the camp.
Signature*

Clear
Date

MonthDayYear
Date

Immunization & Doctor's Physical
(If we already have these documents from within the last 24 months, please continue to the next page. If you are unsure whether the camp has these documents or not, please email or call the camp at office.tmbc@gmail.com or (970) 930-7859.)

If your child will be receiving a physical and immunization records/immunization exemption form at a future date, you may email or mail a copy of those to the camp, as long as we receive them 10 days prior to when he/she attends camp.
Immunization Records or Exemption Form

Cancelof
Doctor's Physical from the last 24 months

Cancelof

Payment & Submission
Please pay with one of these options:
- Pay the Full Camp Price today.
- Pay the Registration Fee Only (will be subtracted from the total payment due upon arrival.)
- Pay the total fee upon arrival at camp.
If you prefer to pay with cash or check, please send your payment to the camp office: 1700 Marble Quarry Rd. Marble, CO 81623.
No payment is required to submit this form.

If you would like to submit a payment at a later date, please hit the "Submit" button below to submit your form without payment. Thank you!

My Products

Registration Fee Only(the remaining balance will be due at camp)

$55.00

Full Camp Price (includes the registration fee)

$270.00

Total

$0.00

Payment Methods

Credit Card

Apple Pay

Google Pay

IF YOU DO NOT RECEIVE A CONFIRMATION EMAIL, WE DID NOT RECEIVE YOUR RESPONSE.
Should be Empty:

COMBO 3 REGISTRATION

Camper Information

Parent/Guardian Information

Church Information

Insurance Information

Emergency Contact

Authorized Person to Pick up Camper

Medical History

Sunscreen Permission

General Release Form

Immunization & Doctor's Physical

Payment & Submission

No payment is required to submit this form.

Payment Methods

IF YOU DO NOT RECEIVE A CONFIRMATION EMAIL, WE DID NOT RECEIVE YOUR RESPONSE.