Online Registration

The below form is to register for our summer camps. Click here to see a list of summer camps.
If you would prefer to view a PDF version of our camping brochure: Cover and Inside.

Want to rent Presmont for your own group? Interested in volunteering or working at Camp Presmont?

2011 Camp Presmont Registration

Campers Name: *
Nickname: *
Address: *
City: *
State/Zip: *
Phone: *
Email: *
Gender:	Male
	Female
Grade Completed: *
Parent/Guardian:
Roomate Preference:
Day Phone: *
Cell Phone:
WorkPhone:
Emergency Contact: *
Phone: *
Relationship to Camper: *
Name of Church:
Church City/State:
Camp Attending:
Name of Adult Attending:
Relationship to Camper:
Medical Insurer: (CAMPERS ARE COVERED UNDER THEIR OWN FAMILY MEDICAL POLICY. CAMP INSURANCE IS SECONDARY AND COVERS CAMPERS IT THERE IS NOT FAMILY INSURANCE).
Policy Holder:
Policy Number:
Cost
Camp Cost: (For Camp Prices Click Here)
Minus Registration Fee: Mail and make checks payable to: Camp Presmont, Inc. 34211 4-H Club Road Piedmont OH 43983 (The registration fee is $25 per camp).
Family Discount: (First registration full-price, each additional $25 off)
Approved Campership Amount: (Camperships are designed to cover the different between what a family can pay and the acutal fee. No comper will be turned away for financial reasons. contact the Registrat to request a campership).
Church Voucher: (Required only if church is paying part or all of camper's fee).
Balance Due Upon Arrival:
Medical Information:
Physician's Name:
Physician's Phone Number:
Allergies:	Nuts
	Hay/Straw
	Bee Stings
	Dairy Products
	Penicillin
Does your child have any other life-threatening allergies?:
Does your child use an inhaler?	Yes
Has your child ever had diabetes?	Yes
Has your child ever experienced homesickness?	Yes
Has your child ever had heart disease?	Yes
Has your child ever had seizures?	Yes
Has your child ever had asthma?	Yes
List any other medical conditions::
Specify any medications your child is bringing::
Date of last tetanus shot::
Activity Restrictions::
Does your child have permission to take Tylenol?	Yes
Name of Father or Legal Guardian::
Name of Mother or Legal Guardian::
Medical Release: In case of an emergency, I authorize Camp Presmont to call a doctor or practitioner to administer medical aid treatment for my child at any time when they believe an emergency exists. In addition, I give parental permission for treatment and/or admission to a medical facility. Release & Indemnity Agreement: In signing this document, I hereby certify that I give permission for my son or daughter to participate in the camping program at Camp Presmont. I also give permission for my son or daughter to be transported in vehicles for camp approved activities. I also authorize Camp Presmont to use photographs, video and audio clips, including those of my son or daughter in camp publicity. In consideration of permission granted the herein named individuals to participate in camping activities, we hereby release and covenant with Camp Presmont that we will never, individually or as legal guardians of said individuals, institute any action at law or in equity for any personal injuries, or injuries to property, real or personal, accused by, or arising out of camping and other related activities sponsored by Camp Presmont, its successors and legal representatives; we further agree to indemnify and hold Camp Presmont harmless against any and all cost, damages and expenses which may be incurred by them as a result of any law suit we might file against them. We understand and acknowledge that camp activities have inherent dangers that no amount of care, caution, instruction or expertise can eliminate and we and the participant expressly and voluntarily assume all risk of personal injury sustained while participating in aforementioned activities whether or not caused by the negligence of the released parties. Signature of Parent or Guardian: Note: If this form is being signed for a minor at the camp, it must be signed by both parents unless one is deceased or mentally incompetent. If there has been a divorce, the party having custody of the child should sign. If the child has no parents, this form must be signed by the legal guardian of the child.	Agree

Summer Contact Information (June - August) Off-Season Contact Information

Camp Presmont, Inc. Leah Rolling

              34211 4-H Club Rd.                                    3680 Wayne Ridge Rd
           Piedmont, OH 43983                                     Zanesville, OH 43701
          740-758-5571                                                 740-674-5112
         presmont@roadrunner.com

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