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Home
About Us
A Typical Day
Camp Policies
Sessions
S.A.L.T.
What To Bring
Testimonials
Our Staff
Staff Information
Staff Resources
Staff Application
Registration
Camper Fees
Camperships
Bring-A-Friend Discount
Support
Corporation Members
Fundraising
News
Lake Darling
Building Projects
The Buck
Contact Us
Board Members
Store
Midwest Bible Camp (MWBC) Camper Application 2022
Before starting, please scan or print the application to be sure you have all the information you need because you will not be able to save the application and come back to it. If you want a copy of the application you submitted, you will need to print this page PRIOR to hitting SUBMIT at the bottom. If you have any questions about completing the application, please send an email to
[email protected]
.
Personal Information
*
Indicates required field
Sex
*
Male
Female
Name
*
First
Last
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Camper Email
*
Birth Date
*
Age at Camp
*
Grade in the Fall
*
If you have just graduated from high school, enter "College" or "Graduate"
Home Church
*
If none, enter "NONE"
Home Church City, State
*
If none, enter "NONE"
Baptized
*
Yes
No
Parent/Guardian Name(s)
*
Parent/Guardian Email
*
Home Phone Number
*
Cell Phone Number (Camper)
*
Work/Cell Phone Number (Dad)
*
Work/Cell Phone Number (Mom)
*
Emergency Contact (Not Parent)
*
Emergency Contact Phone Number 1
*
Emergency Contact Phone Number 2
*
T-Shirt Size (included in Camper Fee)
*
Child 8-10
Child 10-12
Child 14-16
Adult Small
Adult Medium
Adult Large
Adult XL
Adult 2X
Adult 3X
Adult 4X
Medical Information
Date of Last Tetnus
*
List any physical conditions, allergies, or infectious conditions (see #3 Camp Policies)
*
If none, enter "NONE"
List any current medications being taken
*
If none, enter "NONE"
List any special precautions, which should be observed at camp
*
If none, enter "NONE"
Insurance Information
The camper's family insurance is the primary source of coverage for accidents and sickness. The camp insurance pays only a limited amount for accidents and sickness not covered by your family insurance.
Insurance Company Name
*
If you do not have insurance, enter "NONE"
Insurance Company Address
*
Line 1
Line 2
City
State
Zip Code
Country
Name policy is in
*
First
Last
Group Number
*
Policy Number
*
Insurance Company Phone Number
*
Sessions Attending
Remember to submit a $10 deposit for each session you are planning to attend. Pay your deposit(s) by Paypal or mail them to: MWBC; 1201 N 5th Street; Clear Lake, IA 50428.
Check which Camp Session(s) you plan to attend
*
Junior (6/7-6/14, Grades: 4th-6th, Fee: $130)
Intermediate (6/21-6/28, Grades: 7th-9th, Fee: $130)
Senior (6/14-6/21, Grades: 10th-H.S. Graduate, Fee: $130)
Special 0 (6/28-7/5, Grades: 4th-H.S. Graduate, Fee: $130)
Special 1 (7/26-8/2, Grades: 4th-H.S. Graduate, Fee: $130)
Special 2 (8/2-8/9, Grades: 4th-H.S. Graduate, Fee: $130)
Girls Retreat (7/13-7/17, Grades: 4th-H.S. Graduate, Fee: $75)
SALT 1 (6/7-6/14, Grades: 10th & Up, Fee: $65)
SALT 2 (6/21-6/28, Grades: 11th & Up, Fee: $0)
Grade is the Camper's School Grade in the Fall
Bring-A-Friend Discount
List names of qualifying friends (see requirements below)
For each friend you bring to MWBC (up to 3), you can receive $10 off your registration fee, up to a total of $30. To quality, your friend: 1) must be a first time camper to MWBC; 2) cannot be a member of your immediate family; 3) must attend the same week as you; 4) must be listed in the "Bring a Friend" portion of your application; 5) must submit their application at least two weeks before the session; and 6) must not be attending on a Campership. The Bring a Friend discount for Girls Retreat is $5.
Friend Name 1
*
First
Last
Friend Name 2
*
First
Last
Friend Name 3
*
First
Last
Midwest Bible Camp General Policies
The MWBC Board of Directors has formulated the following policies, which are general in nature. Camp directors have full responsibility for interpretation and administration of these policies. Please contact your specific session's director for details or questions.
All camp activities will be under the supervision of one or more of the camp staff.
All campers shall participate in all Bible classes unless excused by the Camp Director.
All physical health will be under the supervision of the Camp Nurse.
Medication in
original containers
must be submitted to the Nurse at arrival with instructions for use and will be administered by the Nurse.
Any infectious condition (such as Pink Eye, Ring Worm, Head Lice, etc.) shall be under effective treatment prior to coming to camp.
Personal hygiene, cleanliness and neatness are required of everyone at camp.
All swimming must be supervised by the Certified Camp Lifeguard.
The following are strictly
not allowed
at camp:
Tobacco, alcoholic beverages, illegal substances (drugs)
Firearms, knives or other weapons
Fireworks, matches, cigarette lighters
Music and/or video players and similar electronic devices, magazines or comics, no posters
No hazing or physical / verbal abuse is allowed.
Campers may not leave their cabins after lights out without permission.
Damage and defacing of the camp facilities, equipment or property will not be tolerated.
Vehicles driven to camp by campers under age 19 shall be registered and the keys left with the camp director.
Phones and other communication devices should be left with the camp director if brought.
MWBC Dress Code
All clothing brought by campers must be modest and suitable for camp wear. We are attempting to remove all distractions. Dressing so as to be a distraction does not further that goal. It is up to the Camp Directors and the staff to determine if a camper is dressed properly. If dress is not appropriate, the camper will be expected to change their clothes and put on something more acceptable.
Short shorts are not acceptable: "knee length" is a good standard.
Tight fitting clothing (including body suits and biking shorts) is not acceptable unless covered by looser fitting clothes.
Transparent or revealing clothing (including tank tops, muscle shirts, midriffs and halter tops) is not acceptable (girls or boys).
No under clothing should be seen, outside of your cabin.
Electronic Signatures
I have read the Camp Policies and MWBC Dress Code and agree to abide by all rules and regulations.
By checking Yes below, I understand that I am electronically signing this document.
*
Yes
Camper Name/Signature
*
First
Last
As parent or guardian, I understand that First Aid will be available at camp and if a serious injury or illness develops, medical and/or hospital care will be given. If it is not possible to contact me or if I am incapacitated, I give permission for emergency treatment or surgery as recommended by the attending physician.
By checking Yes below, I understand that I am electronically signing this document.
*
Yes
Parent/Guardian Name/Signature
*
First
Last
Submit