PDO 2025 REGISTRATION

Registration Form

Parent's Day Out 2025
CAMPER (PARTICIPANT) INFORMATION

A registration form will need to be filled out for EACH participant.
Preferred Name
Legal Name*

First NameLast Name
Birthdate*

MonthDayYear
Gender Identity
Select Full or 1/2 DAY*
GUARDIAN INFORMATION
Guardian Name*

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

Street Address

Street Address Line 2

CityState

Zip Code

EMERGENCY CONTACT

Please list a second contact in case the primary guardian cannot be reached.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Relation to Camper*
"OTHER" - AUTHORIZED PERSONS

If needed, list 1-2 "other" people that may check-in / check-out or transport your camper. Camp Burton cannot release campers to anyone who is not listed on this registration form.
Name

First NameLast Name
Name

First NameLast Name

ADDITIONAL DETAILS
The camper...*

is new to Faith Adventure Camphas attended Faith Adventure Camp before
How did you hear about our programs?
Shirt Size*
Cabin-Mate Request
We cannot guarantee these requests. Campers must be in the same session and within 1-2 years of age.

CAMPER INTAKE QUESTIONNAIRE & MEDICAL PERMISSIONS
Does the camper have any dietary needs or restrictions?
Our kitchen can accommodate and/or provide substitutions for most food allergies. Please be aware that our food may contain or come into contact with common allergens, such as dairy, eggs, wheat, soybeans, tree nuts, peanuts, fish, shellfish or wheat. While we take steps to minimize risk and safely handle the foods that contain potential allergens, please be advised that cross contamination may occur, as factors beyond our reasonable control may alter the formulations of the food we serve, or manufacturers may change their formulations without our knowledge. Camp Burton maintains a "peanut-free" kitchen.
Does the camper have medication (OTC or prescription) that will need to be administered during the day? *Please include emergency medication(s) such as an epi-pen or asthma inhaler.
List medication(s), time taken & how to administer. *Medication brought to PDO needs to be in it's original container.
Additional health (mental and/or physical) comments, requests, and/or notes.
Has the camper recently recovered from illness or injury or do they currently have an injury or illness we should be aware of? Does the camper have anxieties or fears we should be sensitive to? Are there specific calming, supervision or communication techniques which could improve the camper's experience?
Guardian Initials*

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What are some of the camper's interests?
Favorite hobbies, activities, shows, music, foods, etc.

PERMISSIONS & RELEASE OF LIABILITY
Camp Burton has permission to video/photograph the camper for:

promotional use - onlinepromotional use - print
Signature*

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Date*

MonthDayYear
Date

Registration Form

CAMPER (PARTICIPANT) INFORMATION

GUARDIAN INFORMATION

EMERGENCY CONTACT

"OTHER" - AUTHORIZED PERSONS

ADDITIONAL DETAILS

CAMPER INTAKE QUESTIONNAIRE & MEDICAL PERMISSIONS

PERMISSIONS & RELEASE OF LIABILITY

PAYMENT

Paying By Mail or In-Person

DSHS/DDA Contact

Campership Request