First Name *

Last Name *

Street Address *

City *

State *AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip *

Date of Birth *

Gender *MaleFemale

T-Shirt Size *Youth MYouth LAdult SAdult MAdult LAdult XLAdult XXL

Upcoming Grade Level
in the fall *Less than 4th grade4th - Junior Camp5th - Junior Camp6th - Junior Camp7th - Junior Camp8th - Junior Camp9th - Senior Camp10th - Senior Camp11th - Senior Camp12th - Senior CampGraduated - Senior Camp

School
Type *Public SchoolPrivate SchoolHome SchoolOther

Camper's Email Address

Camper's Cellphone

I have a bunkmate request.

First Name *

Last Name *

Relationship *

Phone *

Email * (all camp communication will be sent to this address)

First Name

Last Name

Relationship

Phone

Email

The Hutchinson Bell is Florida College’s alumni and friends’ association which exists to serve members by allowing them to connect, communicate and cultivate relationships with one another and the college which brought them together.

I am interested in joining The Hutchinson Bell.

I am already a member of The Hutchinson Bell.

Name *

Relationship *

Phone *

Name

Relationship

Phone

Does this camper have any physical or medical condition that we should know about (something that might limit participation in any camp activity)? * YesNo

Conditions *Frequent Ear InfectionsFrequent HeadachesHeart Defect/DiseaseSeizuresDiabetesBleeding/Clotting DisorderBreathing DifficultyDizziness/FaintingActive InjuriesPhysical HandicapsAsthmaPshycological DisorderBehavioral IssuesNone

Additional Conditions

Allergies *Hay FeverPoison IvyInsect StingPenicillinAsthmaNone

Additional Allergies

Has this camper had a tetanus shot in the past five (5) years? * YesNo

Has this camper been hospitalized or treated by a physician within the last year? * YesNo

If yes, please describe. 

Will he/she bring medication to camp? * YesNo

If yes, please specify medication, frequency and dosage. 

Has the camper menstruated? * YesNo

If not, has she been told about it? * YesNo

Any Special Considerations

Is this camper covered by Medical Insurance? * YesNo

Insurance Company Name
optional

Insurance Company Policy No.
optional

Insurance Company Phone Number
optional

Is this camper current on all immunizations? * YesNo

Please list any missing/exempted vaccinations

NOTE: Please be aware that in the event of an epidemic of a communicable disease and it is deemed unsafe by the North Texas Hutchinson Bell Board for unvaccinated individuals to attend camp, the North Texas Hutchinson Bell Board (at its sole discretion) reserves the right to cancel the application and refund the fee for any individual unable to provide documentation of their immunization history.

Please list any special instructions or information
that you feel the Medical Staff needs to know
about your camper:

Does this camper have any physical or medical condition that we should know about (something that might limit participation in any camp activity)? * YesNo

Conditions *Frequent Ear InfectionsFrequent HeadachesHeart Defect/DiseaseSeizuresDiabetesBleeding/Clotting DisorderBreathing DifficultyDizziness/FaintingActive InjuriesPhysical HandicapsAsthmaPshycological DisorderBehavioral IssuesNone

Additional Conditions

Allergies *Hay FeverPoison IvyInsect StingPenicillinAsthmaNone

Additional Allergies

Has this camper had a tetanus shot in the past five (5) years? * YesNo

Has this camper been hospitalized or treated by a physician within the last year? * YesNo

If yes, please describe. 

Will he/she bring medication to camp? * YesNo

If yes, please specify medication, frequency and dosage. 

Is this camper covered by Medical Insurance? * YesNo

Insurance Company Name
optional

Insurance Company Policy No.
optional

Insurance Company Phone Number
optional

Is this camper current on all immunizations? * YesNo

Please list any missing/exempted vaccinations

NOTE: Please be aware that in the event of an epidemic of a communicable disease and it is deemed unsafe by the North Texas Hutchinson Bell Board for unvaccinated individuals to attend camp, the North Texas Hutchinson Bell Board (at its sole discretion) reserves the right to cancel the application and refund the fee for any individual unable to provide documentation of their immunization history.

Please list any special instructions or information
that you feel the Medical Staff needs to know
about your camper:

All Junior Campers need to register for the afternoon activities of their choice. The activities will be assigned based on "first come first served". Please select a different activity in each box. Activities will vary based on age. Only age appropriate choices will show in the menus below. To help you make a decision, below are some links explaining some of the craft choices.

All Junior Campers need to register for the afternoon activities of their choice. The activities will be assigned based on "first come first served". Please select a different activity in each box. Activities will vary based on age. Only age appropriate choices will show in the menus below. To help you make a decision, below are some links explaining some of the craft choices.

All Junior Campers need to register for the afternoon activities of their choice. The activities will be assigned based on "first come first served". Please select a different activity in each box. Activities will vary based on age. Only age appropriate choices will show in the menus below. To help you make a decision, below are some links explaining some of the craft choices.

All Senior Campers need to register for the activities of their choice. The activities will be assigned based on "first come first served". Please select a different activity in each box. Once an activity is full for that day it will be removed from the list. To help you make a decision, below are some descriptions of the activities.

NOTE: Chosen activities CANNOT be changed at camp. To increase camper enjoyment and involvement, please consult your camper before choosing activities on their behalf.

This year Florida College will have their staff photographer at Senior Camp the first few days for camp, July 17th-19th. We need to obtain a release for any photos that might be taken of your camper. Please agree/disagree to the release described below.

I, hereby grant permission to Florida College Camp representatives, to take and use: photographs and/or digital images of my child or myself for use in news releases and/or Florida College promotional materials. These materials might include printed or electronic publications, websites, or other electronic communications. I further agree that my child’s or my own name and identity may be revealed in descriptive text or commentary in connection with the image(s). I authorize the use of these images without compensation to me. All negatives, prints, digital reproductions shall be the property of Florida College representatives.