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2023 M4 Camp

It will take place July 19-21, 2023. The deadline to register is March 31. Cost is $260.00 per child. Please contact Lisa Furlow @ 601-320-2629 with any questions.

To make a balance payment on your registration, go here.

Medical Release Form

We need both an emergency authorization for each child and adult attending M4 Camp. In addition to the FBCB form the Waukaway Springs needs a release form as well. Once you submit the form here you will be redirected to the Waukaway Springs website to complete their form.

Create New Account > You’ll fill out with your (Parent/Counselor) info> Enter your phone number and email address> It may ask for Campers (Childs) Info> It will use the DOB to either assign a Youth or Adult form> It will ask if you have received a GHR ID, this is a GroupHold ID made specifically for your group- it is “M4Brookhaven”> Add their information> Fill out the forms completely to register the camper.

This Medical Release Form is for:(Required)

My child

A Chaperone/Parent

Child's Information

Name(Required)

First Last

Does your child have an allergic reaction to any of the following?*(Required)

To bee stings, bites, etc

penicillin

other medicines?

particular foods?

No, my child does not have any medical allergies.

Is there any medical information you feel we should have concerning your child? If none, please indicate "none".(Required)

ALL MEDICINE MUST BE TURNED OVER TO THE CHURCH CHAPERONES BEFORE LEAVING!

Parent Name(Required)

First Last

Email(Required)

Best Contact Phone(Required)

Adult / Chaperone

Name(Required)

First Last

Email(Required)

Phone(Required)

Address(Required)

Street Address City State ZIP Code

Does you have an allergic reaction to any of the following?(Required)

To bee stings, bites, etc

penicillin

other medicines?

particular foods?

No, my child does not have any medical allergies.

Is there any medical information you feel we should have? If none, please indicate "none".(Required)

Medical Information

Doctor's Name

Phone

Insurance Carrier(Required)

Policy Number:

Consent(Required)

I agree to the authorization.

Emergency Authorization – While transporting to/from M4 camp. In case of an emergency, I authorize Lisa Furlow to assume guardianship of my child, and the attending physician to administer treatment and medication until I can be contacted. In addition, I have, and do hereby, release the church, its employees or agents from liability associated with participation in a church activity. I understand that if I do not have medical insurance, I, as the parent or guardian, will be responsible for any medical expenses in the event of a sickness and/or injury.

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The event is finished.

Date

Jul 21 2023

Expired!

Time

All Day

Category

Children

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First Baptist Brookhaven

200 E Monticello St.
Brookhaven, MS 39601
(601) 833-5118
info@fbcbrookhaven.org

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