Pilgrim Application

First Name(*)
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Last Name(*)
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Street Address(*)
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City(*)
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State(*)
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Zip Code(*)
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Phone(*)
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Gender(*)

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Age(*)
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Emergency Contact Name(*)
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Emergency Contact Phone(*)
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Statement of Beliefs(*)
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Do you agree with our beliefs as stated on the website? A copy can be found under the Applications tab.

Policies(*)
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Have you read, understand and agree with the CFRTD Policies Statement? A copy can be found under the Applications tab.

Church Attending(*)
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Are you a pastor?

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Are you married?(*)

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Has your spouse attended Tres Dias?

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Our camp has bunk beds, are you willing and able to sleep on an upper bunk?(*)

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Do you have any medical issues that we need to be aware of?
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If you currently have a medically required diet, please specify what that is. Our camp has some ability to accomodate you if we know ahead of time.
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Do you smoke? (*)

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Sponsor's Name(*)
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Please enter the email of the person that is sponsoring the pilgrim. If you do not have the sponsor's email, please leave this blank.
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I hereby acknowledge my willful decision to attend Camp Elim and to participate in all activities. I will not hold Camp Elim or its agents liable for injury caused by common accident, illness or the rendering of emergency care. This release includes participation in any off-site activities during camp and to be transported to and from these activities, including emergency situations (if any) by authorized vehicles.
I understand that in the event of an emergency, every effort will be made to contact a responsible relative of the camper. In the event that contact cannot be made, I hereby give my permission to the camp administration and the physician they may select to secure proper treatment for, to hospitalize, and to order such injections, anesthesia or operations as may be urgently necessary for me. In the event of a claim, family insurance (if any) will be billed. Camp Elim's insurance provides secondary coverage for injuries sustained at camp.
Camp Elim Release Form(*)
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Camp Elim requires a release, by clicking this button, you are authorizing us to release your name, emergency contact and phone number and your consent to the above two items to Camp Elim. This information will not be released by us or Camp Elim for any use other than in an emergency during the weekend. After the weekend, all information is destroyed.

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Thank you!