Camp 2027 - Camper Application 1Parent / Guardian Information2Camper Information3Medical Information4Other Information5Release of Liability6Camper Agreement7Sponsor Information This field is hidden when viewing the formJr. High / High SchoolJr. HighHigh SchoolThis field is hidden when viewing the formCabin AssignmentCABIN NOT ASSIGNEDFemale CabinsTwin Oaks 1Twin Oaks 2Twin Pines 1Twin Pines 2AshBirchCattailDogwoodElmFirGooseberryHeatherIvyJuniperKnotty PineLodgepoleManzanitaMale CabinsNutmegOliveOakPoplarPonderosaQuaking AspenRedwoodSageToyonValley OakWillowYuccaCedar Lodge 1Cedar Lodge 2Cedar Lodge 3Cedar Lodge 4Cedar Lodge 5Cedar Lodge 6Cedar Lodge 7Cedar Lodge 8Cedar Lodge 9RV ParkNo Overnight Stays At CampThis field is hidden when viewing the formColor TeamCOLOR TEAM NOT ASSIGNEDRedBlueGreenYellowThis field is hidden when viewing the formStart Date of Camp (Do not Adjust)MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920This field is hidden when viewing the formCamper Age (At start of camp)This field is hidden when viewing the formDate SubmittedParent / Guardian InformationParent / Guardian Name(Required) First Last Parent / Guardian Contact Phone(Required)Parent / Guardian Alt. Contact PhoneParent / Guardian Email(Required) Relationship to Camper(Required)Select RelationshipMotherFatherLegal GuardianAddress(Required) Street Address Address Line 2 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 Secondary Parent / Guardian Name First Last Relationship to Camper(Required)Select RelationshipMotherFatherLegal GuardianSecondary Parent / Guardian Contact Phone(Required)Secondary Parent / Guardian Alt. PhoneNon-family Emergency Contact Name First Last Non-family Emergency Contact Phone(Required) Camper InformationCamper Name(Required) First Last Camper Preferred NameGender(Required)Please select a genderMaleFemaleBirthday(Required)MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Grade (Fall 2027)(Required)Please select a Grade6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th Grade13th Grade (Graduated)What grade will the camper be entering in the fall of 2027?T-Shirt Size(Required)Please select a shirt sizeSMLXL2XL3XLAll sizes are Adult UnisexBible Version(Required)Please select a verse card versionKJVNKJVNIV84ESVPlease choose what version of printed verse card your camper will be using during camp.Camper Photo(Required)Max. file size: 2 GB. Please upload a recent photo of your camper for identification and safety purposes. The photo should clearly show the camper’s face and be similar to a school or passport photo. The photo will be used for camp administration purposes only and will not be shared outside of authorized camp staff.Roommate PreferenceIf this camper has friends who are coming to camp that they would like to be roomed with, please enter those names here. Roommate requests will be honored to the best of our ability, but they are not guaranteed. Team colors are assigned randomly, not by request!Camper History(Required)1st Year!2nd Year3 or more yearsHow long has this camper been attending HSDC?How did you hear about HSDC?(Required)Google SearchChurchReferred by another camperSocial MediaOtherSince this is this camper's first year coming to HSDC, we'd like to know how you heard about us!Name of the camper who told you about us!(Required) First Last Church ReferencePlease provide a reference, other than a family member, who knows this camper well. This is ideally a Pastor, Youth Leader, Elder, or other Church administrator. We may contact this reference at our discretion based on information provided in this camper application.Reference Name(Required) First Last Reference Email(Required) Reference Phone Number(Required) Medical InformationDoes this camper have medical insurance coverage?YesNoNo insurance coverage.(Required) I agree to the insurance wavier below.I, acknowledge and confirm that I am willingly permitting a minor child, who is under my legal care and guardianship, to participate in activities offered by High Sierra Discipleship Camp. I expressly understand and agree that said participation is without the provision of health insurance coverage. I am fully aware that any medical treatment required as a result of an emergency, accident, illness, or otherwise, will be my sole financial responsibility, and that High Sierra Discipleship Camp shall not be held liable for any medical expenses incurred.Insurance Provider Name(Required)Insurance Policy Number(Required)Insurance Phone Number(Required)Name of Primary Insured(Required) First Last Upload Picture of Insurance CardMax. file size: 10 MB. Please upload a picture of this medical insurance policy card. If you are on your cell phone you can take a picture of the card directly!First Aid and Care RestrictionsThe following medications and treatments may be given to your camper for minor issues (cuts, scrapes, bruises, headaches, etc) by our camp nurses at their discretion. Please check any boxes for items you DO NOT want our nurses to administer without first contacting you. (Note: In emergency situations, our medical staff will make decisions that are in the best interest of your campers health and safety, you will be contacted during all emergency situations.) DO NOT Administer: Tylenol (Acetaminophen) DO NOT Administer: Advil (Ibuprofen) DO NOT Administer: Tums (Calcium Carbonate) DO NOT Administer: Claritin DO NOT Administer: Neosporin DO NOT Administer: Oral Rehydration Therapy DO NOT Administer: Cough Drops DO NOT Administer: Eye Drops DO NOT Administer: First Aid Wound Care (Hydrogen Peroxide, Saline, Betadine, Alcohol Swabs, Neosporin/Wound Gel as needed) DO NOT Administer: Benadryl DO NOT Administer: Hydrocortisone Cream DO NOT Administer: Sunscreen DO NOT Administer: Bugspray Select AllHealth History (Select all that apply): Drug allergies Insect strings Heart condition Hay fever Other allergies Chronic asthma Handicaps Diabetes Food allergies Frequent colds Stomach upset Epilepsy Other Health History Explained(Required)Please explain any health history items selected above.Date of Last Tetanus Shot Leave blank if unknown, or has never had one.Will the camper be on any medication during camp?(Required)NoYesMedication Explained(Required)Provide the Name and Dosage of any medication the camp will be required to take during camp.Medications(Required)Medication NameDosageFrequency Add RemoveConsent(Required) I agree to the medication policy.I understand that if my child requires any medication during camp, it is my responsibility to provide that medication for the duration of camp. Furthermore, I understand that ALL MEDICATION, both over the counter, and prescription, WILL be surrendered to the camp nurse at the time of camp checkin. No medication will be allowed in the cabins.Family Doctor Name First Last Family Doctor Contact Phone Special Needs or RestrictionsAny Swimming or Activity Restrictions?(Required)NoYesSwimming or Activity Restrictions Explained.(Required)Any Dietary or Housing Restrictions?(Required)NoYesDietary or Housing Restrictions Explained.(Required)Adults Authorized to Pickup Camper In Case of EmergencyEnter the names of any adults that will be allowed to pickup your child during an emergency, other than any Parents, Guardians, or Emergency Contacts already listed on this application.Adult Authorized to Pickup Camper - 1 First Last Adult Authorized to Pickup Camper - 2 First Last Adult Authorized to Pickup Camper - 3 First Last Medical Consent and Release of Liability ELECTRONIC SIGNATURE CONSENT By clicking 'I agree' and rendering your digital signature below, you, as the parent or legal guardian, provide your explicit consent for your electronic signature to be applied to the High Sierra Discipleship Camp Medical Release, and Release and Waiver of Liability and Assumption of Risk, and Indemnity Agreement. You acknowledge and agree that this electronic signature is legally binding, just as your physical signature would be on a paper document. You accept all terms and conditions outlined in the agreement, and you agree to assume all responsibilities and risks associated with your child's participation in the camp activities. Please note, you have the option to opt out of electronic signature submission. If you choose to opt out, you may instead submit a completed paper document to High Sierra Discipleship Camp. To opt out and receive a paper application, please contact our office directly at registrar@camphighsierra.org HIGH SIERRA DISCIPLESHIP CAMP - MEDICAL RELEASE, AND RELEASE AND WAIVER OF LIABILITY AND ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT I, , as the parent or legal guardian of , hereby give my consent and agreement to the following: 1. MEDICAL RELEASE: In case of an emergency, illness, or accident involving my child when I or my spouse/partner cannot be reached, I give permission for High Sierra Discipleship Camp, its employees, agents, volunteers, or other medical personnel to obtain or provide medical treatment for my child, which in their judgment is necessary for the welfare of my child. I authorize them to arrange for such medical and hospital treatment as they deem necessary for the health and well-being of my child. 2. RELEASE AND WAIVER OF LIABILITY AND ASSUMPTION OF RISK: I understand and acknowledge that participation in High Sierra Discipleship Camp activities comes with inherent risks, including but not limited to risk of personal injury, death, illness, damage, or loss. I voluntarily, knowingly, and freely assume all such risks, both known and unknown, even if arising from the negligence of High Sierra Discipleship Camp or others, and I assume full responsibility for my child's participation. 3. INDEMNITY AGREEMENT: I agree to indemnify and hold harmless High Sierra Discipleship Camp, its directors, officers, employees, agents, volunteers, Sugar Pine Christian Camp, and any others acting on its behalf, from and against any and all claims, actions, suits, costs, losses, damages, and any other liabilities, including attorneys’ fees, arising out of or related in any manner to my child’s participation in High Sierra Scholarship Camp activities. This includes, without limitation, any claims of negligence, personal injury, sickness, or death, as well as property damage and expenses, of any nature whatsoever which may be incurred, directly or indirectly. 4. FINANCIAL RESPONSIBILITY FOR MEDICAL TREATMENT: I understand and agree that all costs and expenses incurred in connection with any medical treatment for my child, including but not limited to, physician, hospital, or other healthcare provider expenses, will be my sole responsibility and not the responsibility of High Sierra Discipleship Camp, its directors, officers, employees, agents, volunteers, or Sugar Pine Christian Camp. I understand and acknowledge that High Sierra Discipleship Camp may select medical professionals or facilities that are not "in-network" with respect to my child's health insurance. I agree that in such instances, I am responsible for any and all costs, including those not covered by my health insurance. In the event my child does not have medical insurance, I understand and agree that I am responsible for all medical bills arising from High Sierra Discipleship Camp seeking medical attention for my child. I accept that High Sierra Discipleship Camp will not be responsible for any of these costs or for any costs arising from any injury, illness, or medical condition my child may sustain or experience while participating in camp activities. 5. PHOTOGRAPHIC IMAGE RELEASE: I grant High Sierra Discipleship Camp and Sugar Pine Christian Camps permission to use any photographs, videos, or other media of my child taken during camp activities for all legal purposes, including but not limited to, social media, websites, advertisements, and promotional materials. I understand that these images may be used without further notification, compensation, or royalties, and I waive any rights to inspect or approve the final product wherein my child's likeness appears. I acknowledge that I have read this agreement, fully understand its terms, and have signed it freely and voluntarily without any inducement, assurance, or guarantee being made to me and intend my signature to be a complete and unconditional release of liability to the greatest extent allowed by law. DIGITAL SIGNATURE COMPLIANCE This document has been digitally signed by the user below in compliance with applicable laws within the United States, and the E-SIGN act. DATE SIGNED: 08/25/2026 SIGNER'S IP ADDRESS: 216.73.216.44 SIGNER'S EMAIL: SIGNER'S NAME: Signature(Required) Camper Agreement Please have this camper read, and sign the following: I, , agree to the following: - I will honor and obey the staff and cabin leaders of High Sierra Discipleship Camp. - I will diligently participate in all activities for which I am able. - I will participate in all quite time, bible lessons, devotions, and chapel services. - I will abide by the following dress code: GIRL CAMPERS/LADY CABIN LEADERS & STAFF: - No halter tops or bare midriffs. (If it can’t be tucked in, don’t wear it!) -Swimwear must be modest one-piece style. Clothes must be worn over swimsuits to and from the pool or pond. - Please do not wear clothing that reveals your undergarments (or lack thereof). No spaghetti straps. - No leggings as pants. - Pierced jewelry is limited to earrings. GUY CAMPERS/MEN CABIN LEADERS & STAFF: - Appropriate swimwear. No Speedos. - Shirts must be worn at all times except in the pool, shower or cabin. - Tank tops must be tight fitting around the arms - No pierced jewelry. IF IN DOUBT, LEAVE IT OUT! Please come to camp ready to worship our Lord!Signature(Required) Sponsor InformationIs this camper sponsored?(Required)NoYesSelect yes if somebody other than yourself will be making a payment(s) toward your child's registration. This can be a partial or a full sponsorship, and you and the sponsor will be able to make payments after this application has been submitted.Is a Church Sponsoring Your Child?(Required)YesNo, an individual is sponsoring my camper.Is a church sponsoring your child, either in part, or in full?Church Name(Required)Calvary Baptist Church of LompocCountry Oaks Baptist ChurchCrossponite Church, SangerGrace Community Church, MaderaOakhurst Evangelical Free ChurchPahrump Community ChurchOther/Not ListedChurch Name (Other)(Required)Sponsor Name(Required) First Last Please enter the POC for your sponsor. This can be an administrator at the Church, or an individual who is sponsoring your child.Sponsor Email(Required) Please enter the correct email address for your sponsor. Our website will automatically email your sponsor with instructions on how to make a payment. If you use an incorrect email address, it may delay your application processing!Sponsor Phone(Required)
