Mini Camper Registration Form Mini Mission Registration Please fill out One Form per child. Step 1 of 10 10% Mini Mission Camper InformationCamper's Name* First Last Gender* Male Female Child's Age (and grade if applicable)* What days will your child be at Helping Hands Mission Camp? (If your child will not be at camp every day, please indicate which days they will be with us in the space provided.)* All Week Will your Mini Mission Camper be staying with you at the church during the night? (Child must stay with adult, not in the dorms. Space is limited and sleeping space is reserved for out of town guests first.)* Yes, all week. No. Tee Shirt Size (youth or adult sizes)* Youth Small (size 6) Youth Medium Youth Large Adult Small If affiliated with a church, please enter church name and location: Contact InformationAddress* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneCell Phone (to contact parent or guardian during camp)Email* Mini-Mission CampersDuring Helping Hands Mission Camp week, 3rd through 6th graders will join in a mini-mission, working on light projects in the community. Children younger than 3rd grade will stay at the church while their parent(s) are working in other areas. All children are eligible to attend night activities as long as the parent(s) are with them. See the Children's page at: https://hh-missioncamp.org/registration/children for details. Youth Medical InformationMinor's Full Legal Name* Minor's Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender* Male Female Emergency Contact Name* Emergency Contact Phone* Parent/Guardian # 1 InformationParent/Guardian #1 Name (Full legal name with middle initial)* Parent/Guardian #1 Relationship to Minor* Parent/Guardian #1 Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Parent/Guardian # 1 Phone* Parent/Guardian # 2 InformationParent/Guardian #2 Name (Full legal name with middle initial)* Parent/Guardian #2 Relationship to Minor* Parent/Guardian #2 Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Parent/Guardian # 2 Phone* Allergies/MedicationsAllergies to Medications* Other Allergies* If Applicable please note the conditions for which the child is currently receiving treatmentNote any other significant medical informationNames of Medications, dose and amount taken Authorization and Consent for TreatmentI grant my authorization and consent for Helping Hands Mission Camp (hereafter Supervising Adult) to administer general first aid treatment for any minor injuries or illnesses experienced by the minor. If the injury or illness is life threatening or in need of emergency treatment, I authorize the Supervising Adult to summon any and all professional emergency personnel to attend, transport, and treat my child and to issue consent for any X-ray, anesthetic, blood transfusion, medication, or other medical diagnosis, treatment, or hospital care deemed advisable by, and to be rendered under the general supervision of any licensed physician, surgeon, dentist, hospital, or other medical professional or institution duly licensed to practice in the state in which such treatment is to occur. It is understood that this authorization is given in advance of any such medical treatment, but is given to provide authority and power on the part of the Supervising Adult in the exercise of his or her best judgment upon the advice of any such medical or emergency personnel.Legal Guardian Type Name Here:* Date*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Youth and Children Transportation ReleaseName of Minor* First Last Age or Grade* Parental or Guardian ConsentBy my signature, I grant permission for my minor to ride from the Helping Hands camp location to work sites and activities. NOTE: Helping Hands Mission Camp does not allow minors to ride with drivers under the age of 25. I understand and fully recognize that the transportation of my minor to participate in the projects and activities of Helping Hands Mission Camp (HHMC) involves an element of risk. The undersigned assumes all risks and hazards hereby incidental to such participation and do hereby release, absolve, indemnify and agree to hold blameless HHMC or any of its assigned drivers and shall not hold HHMC responsible for any injury, illness or death as a direct or indirect result of said transportation. Parent/Guardian type name here to give your consent (Full legal name with middle initial)* Date*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Parent/Guardian Phone* Media ReleaseName of Minor First Last Please check one of the choices below and sign the form at the bottom* Permission IS granted for a photo/image of myself, my child and other personal identifiers such as name, age, and camp team to be included on the Helping Hands website, on video, televised or radio broadcasts, or in print media generated by Helping Hands Mission Camp. Permission IS NOT granted for a photo or image of me or my child to be published on the Helping Hands website, televised broadcasts, or in print media generated by Helping Hands Mission Camp. Adult Signature (if 18 or older, type your name here): DateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Parent’s Signature (if under 18, parent type name here): DateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Thank YouYou have completed the Registration form. Please click the submit to submit your application to us.