Sponsor Registration Step 1 of 5 20% Church Attending Camp With(Required)Please select the name of the church you are attending camp with from the list below.Select Church NameBeaver Street Baptist Church, Jenks, OKBentley Baptist Church, Atoka, OKBethel Baptist Church, Wister, OKCalvary Baptist Church, Ft. Smith, ARCentral Baptist Church, Owasso, OKChoteau First Baptist Church, Choteau, OKCommunity Baptist, Coweta, OKCommunity Church, Guthrie, OKCornerstone Fellowship, Tahlequah, OKChisholm Creek Baptist Church, Edmond, OKDeer Creek Baptist Church, Stroud, OKErin Springs Baptist Church, Lindsay, OKExciting Southeast Baptist Church, Pryor, OKFaithWorks of the Inner City, Oklahoma City, OKFinley Baptist Church, Finley, OKFirst Baptist Church, Antlers, OKFirst Baptist Church, Branch, ARFirst Baptist Church, Cassville, MOFirst Baptist Church, Crowder, OKFirst Baptist Church, Elk City, OKFirst Baptist Church, Locust Grove, OKFirst Baptist Church, Newkirk, OKFirst Baptist Church, Ozark, ARFirst Baptist Church, Ramona, OKFirst Baptist Church, Salina, OKFirst Baptist Church, Stigler, OKFirst Baptist Church, Ulysses, KSFirst Baptist Church, Waldron, ARFirst Baptist Church, Wellston, OKFirst Baptist Church Highfill, Siloam Springs, ARFoundation Church, Sapulpa, OKFoyil Baptist Church, Foyil, OKGraceway Baptist Church, Oklahoma City, OKHackett First Baptist Church, Hackett, ARHarbor of Grace Church, Tulsa, OKHaven Heights Baptist Church, Ft. Smith, ARHighland Baptist Church, Moore, OKHope Fellowship Church, Tulsa. OKKeota First Baptist Church, Keota, OKLakeview Baptist Church, Guthrie, OKLenapah First Baptist Church, Lenapah, OKLiberty Baptist Church, Mounds, OKLinden Baptist Church, Gladstone, MOMammoth Baptist Church, Meeker, OKMazie First Baptist Church, Mazie, OKMosaic Comm Fellowship, Siloam Springs, ARNew Beginnings Church, Shawnee, OKNew Church, Oklahoma City, OKNew Harmony Baptist Church, Bartlesville, OKNewspring Family Church, Jenks, OKPecan Valley Baptist Church, Newalla, OKPleasant View Baptist Church, Pryor, OKPocola First Baptist Church, Pocola, OKPruitt Baptist Church, Van, TXRidgecrest Baptist Church, Newcastle, OKRipley Comm Church, Ripley, OKRye Hill Baptist Church, Ft. Smith, ARShady Grove Baptist Church, Greenville, TXShamrock Baptist Church, Shamrock, OKSnow Hill Baptist Church, Tuttle, OKSouthside Baptist Church, Poteau, OKTemple Baptist Church, Shawnee, OKThe Good Fight Church, Yukon, OKTushka Baptist Church, Atoka, OKUtopia Baptist Church, Big Cabin, OKVintage Church, Edmond, OKWann First Baptist Church, Wann, OKWelch Baptist Church, Welch, OKWestern Heights Baptist Church, Cleveland, OKWestport Baptist Church, Cleveland, OKWhitefield Baptist Church, Whitefield, OKMy Church is not listed…Church Camp Week(Required)Please select the week you are attending camp from the list below.Select Camp WeekChildren's Camp – May 28th–May 31st @ GCCYouth Week #1 – June 3rd–June 8th @ KBAYouth Week #2 – June 24th–June 29th @ GCCYouth Week #3 – July 15th–July 20th @ GCCChurch Not RegisteredLooks like your church is not registered yet! Contact your Children’s or Youth Pastor, Volunteer, or Leader and notify them that their church is not listed in the Summit Camps registration form. Sponsor InformationSponsor's Name(Required) First Last Sponsor's Address(Required) 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 Sponsor's Birth Date(Required) MM slash DD slash YYYY T-Shirt Size(Required) Small Medium Large XL 2XL 3XL 4XL Other Gender(Required) Male Female Sponsor Email(Required) Sponsor's Cell Phone(Required) Medical & Emergency InformationPrimary Emergency Contact Name(Required) First Last Primary Emergency Contact Phone(Required)Primary Emergency Contact Relationship to Sponsor(Required) Secondary Emergency Contact Name(Required) First Last Secondary Emergency Contact Phone(Required)Primary Emergency Contact Relationship to Sponsor(Required) Has Sponsor been immunized for Tetanus?(Required) Yes No Date of last Tetanus Immunization(Required) MM slash DD slash YYYY Does Sponsor have a Primary Care Physician?(Required) Yes No Sponsor's Physician Name(Required) First Last Sponsor's Physician Phone(Required)Does Sponsor have any food allergies?(Required) Yes No Please list food allergies below:(Required)Will Sponsor be bringing any medication with them to camp?(Required) Yes No Please list medications below:(Required) CDIB InformationDoes the Sponsor have a CDIB?(Required) Yes No Tribal Nation(Required) CDIB Number(Required) Is the Sponsor Insured?(Required) Yes No Health Insurance InformationName of Insured(Required)Name of the person who carries the insurance for the camper. First Last Address of Insured(Required) 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 Employer of Insured(Required) Insurance Company(Required) Insurance Company Phone(Required)My Insurance Card has the following numbers(Required) Policy Number Group Number Certificate Number Select AllPolicy Number(Required) Group Number(Required) Certificate Number(Required) Mailing Address for Insurance Claims(Required) 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 Liability Release & SignaturesSummit Camps Liability Release Agreement(Required)I will not hold the attending Church, Summit Camps, Kiamichi Baptist Association, Green Country Camp (Green Country Baptist Assembly) responsible for any accident that may occur. I also give permission to receive medical treatment or attention in case of emergency or illness while traveling and/or while under the supervision of above referenced Church, sponsors, and/or camp staff. I expressly understand and acknowledge that during the course of the camp photographs and/or video footage may be taken and I hereby give permission for such photographs or videos to be used on the camp website and/or for promotional materials for the camp. I agree to the Summit Camps liability release.