This form will take a few minutes. It must be completed by the camper's parent/guardian. Be sure to completely fill out each part. Please do not put more than one child on a form. At the end, you will be required to make a deposit online with your credit/debit card or PayPal account.
Today's Date: *
How did you hear about Marannook? *
If you are a first time camper who referred you to Marannook?
Camper's Full Name: *
Camper's Preferred Name (if different from above)
School Grade for the 2019-2020 School Year: *
Date of Birth: *
Sex: * Male Female
Camper T-shirt Size: Youth Small
Parent/Guardian Name(s): *
Phone Number: *
Alternate Phone Number:
Zip Code: *
Emergency Contact (other than parents) *
Emergency Contact Phone Number *
If you do not carry medical insurance please enter NONE in the fields below.
Do you carry medical insurance? * Yes No
Insurance Carrier: *
Policy Number: *
Group Number: *
Are immunizations up-to-date? * Yes No
Was the last tetanus within the last... * 5 years 10 years Other
General Health: *
Special Diet:Please specify the reason. If needed, include sample menu or special food list.
Would you like for us to contact you concerning this special diet need? Yes No
Medications which will be brought to camp:Please specify the medication name(s) and reason(s).
Was the camper’s last physical within 2 years of camp date? * Yes No
Doctor: *Please provide the doctor's name plus office and home phone numbers.
Orthodontist (if camper has braces or retainers):Please provide the doctor's name plus office and home phone numbers.
The following is a complete list of oral over-the-counter medications available at Marannook to treat temporary discomforts that might occur. Please check any medication you DO NOT want given to your child during their stay at camp
Benadryl (elixir and tablets) Dimetap elixir Sudafed tablets Chlortrimeton Robitussin DM Claritin Pepto bismol Tums Emetrol Imodium AD Tylenol (chewable, elixir, Junior/Regular/Extra Strength tablets GasX tablets Halls Cough Drops Docusate sodium Ibuprofen (elixir and tablets) Hydrocortisone 1% cream Alcohol in ear after swimming Antibiotic ointmentPlease note: medications are given only if appropriate for the child’s age, and dosages are based upon the child’s age and weight.
I hereby authorize the administration of any of the above medications, with the exception of those checked, to my child as deemed appropriate and necessary by the Marannook medical staff.
In the event of any emergency, I authorize camp officials to secure from any licensed hospital, physician, and/or medical personnel any treatment deemed necessary for my or my camper’s immediate care and agree that I will be responsible for payment of any medical services rendered.
I also authorize the release of any personal or health information from Marannook to its employees or outside medical personnel, as they deem necessary to insure complete and quality medical care for my camper or myself.
Please select one of the options below:
OVERNIGHT Camp Selection ($775 per week): None
7th-10th Grades (Week 1) June 2-7
1st-4th Grades (Week 2) June 23-28
1st-4th Grades (Week 3) June 30-July 5
5th-7th Grades (Week 4) July 14-19
5th-7th Grades (Week 5) July 21-26Select camp according to grade entering Fall 2019.
DAYCAMP Selection ($395 per week): None
1st-4th Grades (Week 2) June 24-28
1st-4th Grades (Week 3) July 1-5
1st-4th Grades (Week 4) July 15-19
1st-4th Grades (Week 5) July 22-26Select camp according to grade entering Fall 2019. (Lunch is included.)
We have found it best to group campers by their birth dates. One of the benefits of the camp experience is the opportunity to meet new people and make new friends from different areas. It is a joy to see friendships form and grow from the moment the children arrive and get settled in their cabins. Our counselors are specially trained to draw their campers together, foster those relationships from the very beginning and discourage cliques. If you have twins, we ask you to note if you would like them to be together or separated. We fully understand the desire for friends to come to camp together. If campers are not in the same cabin they will have many opportunities throughout the day to interact with one another. They will see each other at meal times, Bible Time, swim time and during many of the camp activities. If you have any specific questions about our cabin placement please call the office at (334) 864—7504.
Marannook requires the execution of the following liability Waiver and Release. Marannook strives to conduct its camping programs and activities in a safe manner and holds the safety of all participants in the highest regard. Parents registering children for camp must recognize, however, that there is an inherent risk of injury when choosing to participate in camp. Marannook continually strives to reduce such risks and insists that all staff and campers follow safety rules and instructions which have been designed to protect the campers.
Please read this form carefully and be aware that in registering your camper for camp you will be waiving and releasing all claims for injuries, damages, or loss you or your camper might sustain through participation while at Marannook. Please call if you have questions about any of the following activities.
As a parent/guardian of a camper at Marannook, I recognize and acknowledge that there are certain risks of physical injury, and I agree to assume the full risk of any injuries, damages, or loss which I or my camper may sustain as a result of participating in any and all activities connected with, or in any way associated with Marannook.
I further agree to indemnify, hold harmless, and defend Marannook, its board members, executive officers, staff, and employees from any and all claims for injuries, damages, or loss sustained by me or my camper arising out of, connected with, or in any way associated with Marannook.
I give permission to use any photographs, video tape recordings, and/or sound recordings of the minor named below for promotional purposes. If this is an issue please contact us directly.
Liability Waiver and Release (must be done by parent or legal guardian) * By checking this box, I affirm that I have read and fully understand the above program details and waiver and release of all claims.
A non-refundable deposit of $100 is required to hold your reservation for camp. Deposits are deducted from the total fee. Balance is due by the first day of camp. If you would like to go ahead and pay for this years t-shirt please select that option below.
Please select one of the options below. * Overnight Camp full payment of $775 Overnight Camp full payment of $775 plus $15 t-shirt Day Camp full payment of $395 Day Camp full payment of $395 plus $15 t-shirt $100 deposit $100 deposit plus $15 t-shirt Partial payment of $200 Partial payment of $200 plus $15 t-shirt Partial payment of $300 Partial payment of $300 plus $15 t-shirt Partial payment of $400 Partial payment of $400 plus $15 t-shirt Partial payment of $500 Partial payment of $500 plus $15 t-shirt Partial payment of $600 Partial payment of $600 plus $15 t-shirt
If you register for Overnight Camp on Family Night and complete the balance due by October 31st you will receive the Super Early Bird price of $675. Day Camp Super Early Bird price is $345 if you register on Family Night and complete the balance due by October 31st. We also have a Referral Program in place. If you refer a new camper you will receive a $100 credit toward your camper's balance. Pastoral Discount is available upon request.
Please send an email to email@example.com or call 1-334-864-7504 to request a scholarship application.
Comments or Promotional Code: