Middle School Camp

||June 20th- 24th|| New Time, Same Place

After the Elementary Camp, campers finishing the 6th grade all the way through campers finishing the 8th transition into our Middle School Camp.   Campers must have attended at least one year of Elementary to be eligible for Middle school Camp.

Middle School forms are mailed out directly to Campers!!
For more information contact us at: outdooroutreach.inc@gmail.com

Because of generous donations and grants and through the work of amazing volunteers; Middle School Camp is Free along with Lunch and Transportation

    Outdoor Outreach Camp Registration Form

    Email Address:

    Camper's Information

    First Name:

    Last Name:

    Gender:MaleFemale

    Date of Birth:
    Example 03/02/2008

    Address:

    City:

    State:

    Zip:

    Child's Home Phone:

    Grade (Completed as of May 2022):

    School:

    T-shirt size:

    Is this your first year at camp?

    Parent/Guardian - Medical Emergency Contact & Pick up Release Consent

    Parent/Guardian #1

    First Name:

    Last Name:

    Address:

    City:

    State:

    Zip:

    Work Phone:

    Cell:

    Employer:

    Parent/Guardian #2

    First Name:

    Last Name:

    Address:

    City:

    State:

    Zip:

    Work Phone:

    Cell:

    Employer:

    Child Lives With

    Additional Medical and Alternate Pick up Release

    Name:

    Relationship:

    Phone:

    Name:

    Relationship:

    Phone:

    Medical Release Information

    Please list any medical problems, including any requiring maintenance medication(i.e. Diabetic, Asthma, Seizures).

    Is your child presently being treated for an injury or sickness, or taking any form of medication for any reason?
    YesNo
    If yes, explain

    Is your child allergic to any type of food or medication?
    YesNo
    If yes, explain

    Transportation Information

    Please select the Pick-up & Dropping off Location
    New Life ChurchHackett Elementary SchoolRiverview Elementary SchoolParent drop off / pick up

    Parent/Guardian Consent

    I understand that I will be notified in the case of a medical emergency involving my child. In the event
    that I cannot be reached, I authorize the calling of a doctor and the providing of necessary medical
    services in the event my child is injured or becomes ill. I hereby give consent to Outdoor Outreach or
    Representatives to secure emergency medical treatment through the nearest trauma center, hospital,
    or care facility for my child. I understand I am responsible for the resulting medical bills.

    I hereby give permission for my child to be photographed during the camp, to be used on the website
    and also to publicize events.

    I hereby give permission for my child to participate in physical walking trips, field trips, special
    excursions to places of interest, bus trips, van trips, and other field trips and activities sponsored by
    Outdoor Outreach. I also give consent for my child to participate in physical fitness activities
    sponsored by Outdoor Outreach. I understand and acknowledge that my child will hear a Christian
    message during camp. Outdoor Outreach is not affiliated with any school district.

    Outdoor Outreach and it’s co-organizers are not responsible for lost or damaged personal property.

    I do hereby agree to hold free from any and all liability Outdoor Outreach, Williams Tree Farm, LLC,
    Rockton, IL, and it’s respective officers, volunteers, employees, sponsors and member and do herby
    for myself, my heirs, executors, and administrators waive, release and forever discharge any all rights
    and claims for damage which I may hereafter accrue arising out of or in connection with my child’s
    participation in any of the activities of Outdoor Outreach.

    Printed Name of Parent/Guardian:

    Parent/Guardian Signature:


    Please sign above blue box with mouse or finger. The clear button will reset the signature area.