2026 Big Overnighter

March 6 4:30 pm

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Student Full Name

Grade:

Student Birthdate:

Parent/Legal Guardian

Parent Phone Number

Parent Email

Alternate Emergency Contact

Emergency Contact Relationship to Student:

Emergency Contact Phone Number:

I acknowledge that participation in the activity described above involves risk to the participant and may result in various types of injury including, but not limited to, the following: sickness, bodily injury, death, emotional injury, personal injury, property dam age, and financial damage. In consideration for the opportunity to participate in the activity described above, our group acknowledges and accepts the risks of injury associated with participation in the activity. We accept personal financial responsibility for any injury or other loss sustained during the activity or while at/on Oil Belt Christian Service Camp’s facilities and property. By signing below , I am giving consent for above listed student to attend the activity described above. I will in no way hold Oil Belt Christian Service Camp, it’s board, staff or management responsible for any accident that might befall the participants. I, also, agree that said student will abide by the camper code of conduct. I, also, authorize Oil Belt Christian Service Camp to use an y pictures, videos, or slide as may be needed for its records or public relations program.

Camper Code of Conduct: I understand that I am required to conform to the camp schedule.  If I willfully or intentionally damage equipment or property, I will replace at my (the camper’s) expense.  I understand OBCSC reserves the right to dismiss any camper for und esirable conduct including, but not limited to, possession of harmful or illegal substances, bullying, distracting others, and showing disrespect.  I will not bring snacks, food or drinks to camp since they are not allowed in the dorms.  I will conform to the dress code. Modesty and decency must prevail in my clothes. Short or tight shorts, bare midriff or revealing clothing are not permitted. (full dress code online at oilbelt.com)  I will not bring or keep a cell phone or electronic device at OBCSC

I give my child permission to be transported by West Salem FCC to and from the Oil Belt Campus where the event is taking place.

I agree to pay $20 for registration

Signature of Parent/Guardian

Signature of Student: