Day Camp Ages 6-12
Primary Ages 6-9
Junior Ages 8-11
Pre-Teen Ages 10-13
Jr. High Ages 12-15
Sr. High Ages 14-18
Spring Work Day
AMBUSH REGISTRATION FORM
Michigan state regulations require the name of the person(s) to whom we may release your child. Please release my child to:
In case of emergency, the camper’s personal health insurance will be used before Camp Selah’s coverage.
Date of Last Tetanus Shot
Allergies (Check all that apply)
Poison Ivy-severe reaction
Other Allergies (Please List)
Medicinal Allergies (Please List)
Food Allergies* (Please List)
*Find our special diets policy on the Important Info for Parents Page
List All Allergies
Health History (Check all that apply)
Emotional or Behavioral Disorders
Other health and/or behavioral considerations
All medications brought to camp must be in their ORIGINAL CONTAINERS with dosage/frequency labeled accordingly.
“I hereby certify that the above information is correct, and give permission for the use of photographs or videos including my child to be used in camp publicity, and for the release of medical records in case of illness or injury. In the event that my child's emergency contact cannot be reached, I hereby give permission to the physician selected by Camp Selah to give emergency medical or surgical treatment and routine non-surgical medical care to my child.” PARENT/GUARDIAN ELECTRONIC SIGNATURE
Please fill out the fields marked with an asterisk.