Christian Bible Camp serving New Jersey, New York and Pennsylvania located at TriState Bible Camp, online registration form.

Youth Online Registration Form
Registration is a two part process:
1. Complete the registration form for the camp/retreat of your choice. Click the Submit Registration Form button.
2. A $25.00* registration fee per person is required.
*An additional $1.00 online processing fee will be billed per person for online registrations.
Once you have Submitted the Registration Form you will land on a page to make your payment through PayPal via a secure transaction, using a major credit card or your PayPal account.

Required Fields*
*Name:
*Gender: *Age: *Date of Birth:
*Grade Entering:
*Address:
*City: *State: *Zip Code:
*Phone:
*email:
Church Name:
Church Phone:
Church Address:
City:
State: Zip Code:
Pastor's Name:
Your choice of one roommate:

Medical Information
Medications taken regularly:
(All medications sent to camp should be in their original labeled containers
with proper dosing instructions attached.)

Pre-existing conditions:

Allergies:

Immunizations * All Below are REQUIRED Fields
Each camper must be immunized against the following: (Please give the date of each shot.)
* Polio:
* Measles:
* Mumps:
* Rubella:
* Diphtheria:
* Tetanus:
* Whooping Cough:
* Physician’s Name:
* Physician’s Phone:
* Emergency Contact Name:
* Emergency Contact Phone:
* Insurance Provider: If no insurance please enter ‘none’ in the box.
* Insurance Provider Phone: If no insurance please enter ‘none’ in the box.
* Policy Number: If no insurance please enter ‘none’ in the box.

*Retreat/Camp Attending:

*Parental Permission: I have read the general information section in this brochure, and I agree to support TSBC is their dress and conduct regulations for my child while at camp. I understand that the camp reserves the right to send campers home that are non compliant with TSBC’s standards. In the event of an emergency, I hereby give permission to the directors and/or camp nurse at Tri-State to act as my agent in seeking medical treatment for my child. I also give my permission to the physicians selected by Tri-State to hospitalize and secure proper treatment and order anesthesia, surgery or any services deemed necessary for my child as named on this registration form. I understand every effort will be made to contact parents or guardians of campers in the event of an emergency. I understand that all off site medical expenses will be billed through the parents health insurance policy. I hereby release the Tri-State Bible Camp/Conference Center of Montague, NJ, 07827 from responsibility and liability for any injury or illness that my child may sustain while a camper at this facility.
* I have read the above information and agree to abide by it.
Please type "Yes" (not case sensitive) and then type your name below.
* In lieu of signature please type in your name:

Additional Comments:

Once you click the Submit button you will find the PayPal button to complete your registration process.