11/12 Conference Registration

Begin Online Registration

Please complete your Registration Form below. If you have a food allergy or dietary restriction, please also complete the Food Allergy Emergency Care Plan.

The balance of the cost is payable online or when you come to camp. If paying when you come to camp, make checks payable to: French Creek Bible Conference.

Questions about the 11/12 Conference can be addressed to:
Director, Andrew O’Donohue

Paper forms for mailing will be made available soon.

Conference

Conference you are registering for*
11/12

Camper Information

Camper Full Name*

Camper Phone (if applicable)

Camper Email (if applicable)

Gender*
MaleFemale

Camper Date of Birth*

Entering Grade*

First Time Camper?*
YesNo

Cabin Mates Preferred

Family Information

Parent/Guardian Full Name*

Parent Cell*

Parent Phone

Parent Email*

Street Address*

City*

State*

Zip Code*

Church Name

Emergency Contact Information (other than parent)

Emergency Contact Full Name*

Emergency Contact Phone*

Insurance & Health Information

The following information MUST be provided, or a photocopy of both sides of the insurance card included with the registration. Any third party medical treatment will be submitted first to the individual's insurance carrier for payment. Any unpaid or uncovered expenses will then be submitted to FCBC's insurance carrier for payment. Any remaining balance is the responsibility of the individual treated.

Name of Insured (i.e. the name of the policy holder)*

Insurance Company Name*

Insurance Company Phone Number*

Group (If Applicable)

ID Number*

Family Doctor*

Date of Camper Last Tetanus Shot*

List any special accommodations (e.g., health, dietary, mental health)

Agreement and Signature

Except as indicated above, I am in good health and am therefore able to participate fully in activities of the conference. I give my permission for hospital treatment in the event of an emergency, and to release any and all pertinent medical information.

The words "execution," "signed," "signature," and words of like import in this Agreement or in any amendment or other modification hereof (including waivers and consents) shall be deemed to include electronic signatures or the keeping of records in electronic form, each of which shall be of the same legal effect, validity or enforceability as a manually executed signature or the use of a paper-based recordkeeping system, as the case may be, to the extent and as provided for in any applicable law, including the Federal Electronic Signatures in Global and National Commerce Act, the New York State Electronic Signatures and Records Act, or any other similar state laws based on the Uniform Electronic Transactions Act.

I agree to the publishing of photos of the conference, which may include my image, with the understanding that such photos will be used solely on the web site, social media, and/or in promotional materials. Photos will not include my name or any other personal information.

I agree to the disclosure of my personal contact information to French Creek Bible Conference Association staff members and the use of such information by staff members for purposes related to the conferences (e.g. letter writing). I also agree to the disclosure of my personal contact information to the Orthodox Presbyterian Church.

I agree that any claim or disputes I have or may have with FCBC Association or its staff will be settled by Biblical based mediation and, if necessary, legally binding arbitration in accordance to the provisions of article XII of the bylaws of FCBC Association.

I have fully read and completely understand conference rules and regulations ("Behavioral Agreement") provided by FCBC, and I promise to abide by those throughout the conference.

Please be aware of the Technology Policy in place for youth conferences.

Signature of Camper*

Date Signed*

The following is required to be completed by the legal parent/guardian for all campers who will be under the age of 18 during the conference:

I certify and agree that my child and I will be bound by the provisions listed above, and where my child's consent is legally insufficient, I hereby consent on his or her behalf to the provisions above. I understand the consequences if my child's behavior is not in keeping with the Christian standards of conduct and the administrative guidelines listed above.

Signature of Parent/Guardian

Date Signed

Payment and Scholarships

Scholarships: Please contact the deacons of your local church if you are unable to pay the full camp fee. If your church is unable to help, contact the director of the conference that you wish to attend.

How would you like to pay for conference registration?
OnlineCash or check, in person

Please be sure to bring cash or a check of the correct total amount to the conference you are attending.

Make checks payable to: French Creek Bible Conference.

Once you've submitted this form using the following submit button, if you would like to pay online please do so here:
Online payment page

A copy of this submission will be sent to the camper email and parent email, if provided.