Dauphin Bible Camp Online Registration

This form is for registering for the Dauphin Bible Camp Summer Camps. Please visit the menu for other camps. Online payment is only accepted through PayPal through our online store. You will be automatically redirected after you submit this form.

Name (*)

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Address (*)

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City (*)

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Province (*)

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Postal Code (*)

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Birthdate (*)

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Gender (*)
Male Female
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Phone Number (*)

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Emergency Number

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email (*)

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Father

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Mother

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Camp Information

Select Camp (*)

Please select a camp. Please select the camp you would like to attend. You will have to select your payment option for this camp at the bottom of this form.

I would like to recieve my confirmation by (*)
emailmail
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Cabin Mate

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Medical Information

Medical Number

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Allergies

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Other Health problems

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Physicians name

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Date of last tetanus shot

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Physicians Phone

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By checking this box I agree to the following: (*)
To the best of my knowledge my child is in good health. I will notify the camp if my child is exposed to an infectious disease during the three weeks prior to camp. In the case of an emergency, contact me. In the event that I cannot be reached, I give permission to the physician selected by the Camp Director to hospitalize, secure treatment, order injections, anesthesia or surgery for my child as named above. I give permission for the Camp Director to authorize the Camp Health Officer to administer over the counter medications to my son/daughter. I accept financial responsibility for the costs incurred in excess of the benefits allowed by provincial health and/or personal medical insurance. I agree to allow photographs or video of camp activities, which may include the child in my care, to be used in camp promotional material or brochures. I agree to allow Dauphin Bible Camp to share personal information (name/ address) with churches affiliated with Dauphin Bible Camp and CSSM Ministries.
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Please Note: This form will send your information to the DBC secretary. After you click submit you will be taken to the DBC Store where you can complete the payment portion of your registration. Simply select the payment option you wish to use and add any other items you wish to your cart. Payment is accepted via PayPal. You do not need to have a PayPal account to use PayPal just select the pay with credit card option. If you are registering multiple campers you can fill out this form for each child and then pay for all their fees in one payment with the shopping cart.

Summer Camp Registration Form

Contact Info