Shelby County Christian Assembly

Online Registration

Now you can pay for camp using your credit or debit card using PayPal!

No PayPal account required.

You can pay the full amount or 50% (since some churches pay half).

Camper Info:
Camp Week Attending:
Gender:
Date of Birth:	MM/DD/YY
Camper Name:
Address Line 1:
Address Line 2:
City / State / Zip:
Contact Info:
Home Phone:
Parent / Guardian:
Home Church:
Minister:
Home Church Phone# :
What church are you attending camp with?
Are you an immersed beliver in Jesus Christ?
Medical Info:
Allergies:
Medications Taken:
Date of Last Tetanus Shot:	mm/dd/yy
Physical Limitations and Needs:
Insurance Company:
Policy Number:
Name on Policy:
Medical and Promotion Release:	I hereby release Shelby County Christian Assembly, its staff and sponsors, from responsibility and liability for any injury or illness that my child may sustain during camp. In the event of an emergency, I hereby authorize an adult staff member, as an agent for me, to consent to any X-ray examination; dental, medical or surgical diagnosis; treatment; and surgeon or dentist (as appropriate) licensed to practice under the laws of the state where the services are rendered, either at a doctor’s office or in any hospital. I expect to be contacted as soon as possible. I understand that if my child does not follow the guidelines set forth at the camp, I will be asked to come and pick my child up or arrange transportation home from the camp. I hereby give permission for photos and videos of my child to be used in promotion of the camp.
I agree to this release:
Work / Cell #:
Emergency Contact #:
Relation to Youth:

Standard Registration

Download Registration Form (PDF)

A parent or guardian must fill out the registration form, completing both the registation and the medical release, and send it to:

S.C.C.A. Registration
c/o Matt Stieger
1816 North Missouri Street
Macon, MO 63552

The registration form must be postmarked by the registration due date listed with each week of camp. One half of the camp fee must be included with the balance due upon your arrival at camp. Some churches have different methods of registering their campers. Please check with your minister or youth minister if you have any questions regarding the registration process.

When you arrive at camp, Check-In will be located in the upstairs of the Retreat Center. Please make this your first stop when you arrive.

Site Questions? Email: questions@scca-online.com