2025 REGISTRATION IS NOW OPEN!!!

Continue scrolling to access Online Registration!

Please click the “Submit” button at the bottom of page to complete enrollment!!!

REGISTRATION DUE

July 17, 2025 @ 5pm

CAMP GLOW 2025

PLEASE READ ALL INFORMATION BEFORE STARTING YOUR REGISTRATION!!!!

Camp Dates: August 4-8 @ Camp Tekoa

DROP OFF TIMES: (grades are as of Fall 2025)

Rising 8th grade - College : Drop off Monday August 4th @ 9am - Pick up Friday August 8th @ 6pm
Rising 5th - 7th Grade : Drop off Wednesday August 6th @ 4pm - Pick up Friday August 8th @ 4pm

Parent Letters: Please download and read thoroughly through the appropriate letter for your child’s age group! These letters contain important information and reminders. There also is a packing list below! Please ensure your child brings what is needed, and make sure that it is labeled! What they bring, they must go home with!!!!!

Packing List for All Ages

Camper Parent Letter : Rising 5th-7th Graders

Counselor/Minion Parent Letter: Rising 8th Grade-College

WELCOME TO THE CAMP GLOW 2025 REGISTRATION FORM!

Please refer to the list above for drop off time information listed above to determine when to drop off your child based on grade level.
Insurance Information- There is a spot for you to provide information & a photo regarding insurance. We ask that you please upload the Insurance Card photo when registering. This is required information needed by our nurse to attend Camp GLOW.
- If there is a reason you cannot, please email it to us ASAP after completing your registration. Email: campglow.shine@gmail.com
If your child has their own life jacket, we ask that they bring it to use during camp. Please label with their first and last name so we can make sure your child returns home with it.

ONLINE REGISTRATION

You MUST be a parent, legal parent/guardian or over the age of 18 to complete registration.

PLEASE BE SURE TO HIT THE “SUBMIT” BUTTON WHEN DONE!

You will receive a confirmation email including additional information within 72 hours of registering! If you do not receive a confirmation email after the 72 hours, please email us before re-registering! That way we do not have duplicate entries! Thank you and we look forward to seeing you in August!

TEAMS WILL NOT BE ANNOUNCED UNTIL AFTER REGISTRATION HAS CLOSED. Only the Lead & Co-Lead Counselors will receive information regarding their teams. Campers and Minions (5th grade-8th grade) You will find out your team placement UPON ARRIVAL!

If you have any other questions between now and Camp time, email us!

campglow.shine@gmail.com

Name of person attending

First Name

Last Name

Birthday

MM/DD/YYYY

Have you attended Camp GLOW before?

Attendee Cell Number

(###)

###

####

Parent Cell Number

(###)

###

####

List an email that you check regularly and that does not have a full inbox! Please also check spelling so that emails are correct & don't bounce back to us!!

Additional Email

If you wish to provide a secondary email for your attending child to receive information as well, please list it here. Again, please double check spelling!

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Grade as of Fall 2025

Reminder: Camp GLOW is for rising 5th grade through college age. If your grade is not listed, please email us at campglow.shine@gmail.com first.

School Attending Fall of 2025

T-Shirt Size

The size you choose is what you will receive when tshirts are passed out during camp!!!

Emergency Contact #1

First Name

Last Name

Relationship to Attendee

Phone

(###)

###

####

Emergency Contact #2

First Name

Last Name

Relationship to Attendee

Phone

(###)

###

####

Does your child take medication?

If yes, Please list in the following 3 boxes your child's morning, mid day & evening medications.

MORNING MEDS

If under 18, and medications are to be given at Camp GLOW, parents must sign a separate permission form & meet with Nurse Kim Henderson at drop off to deliver medications.

MID-DAY MEDICATIONS

If under 18, and medications are to be given at Camp GLOW, parents must sign a separate permission form & meet with Nurse Kim Henderson at drop off to deliver medications.

EVENING MEDICATIONS

If under 18, and medications are to be given at Camp GLOW, parents must sign a separate permission form & meet with Nurse Kim Henderson at drop off to deliver medications.

Physician name, address & phone number

Insurance Information

If you do not have insurance, please type N/A.

Please list any medical/behavioral concerns that we need to be aware of.

Please list any FOOD Allergies that your child may have.

We communicate directly with the chef at Camp Tekoa to ensure that there is something for everyone to eat who has any allergies/intolerances

Can your child swim?

Parents, please note that lifejackets are provided and required for every attendee of Camp GLOW to participate in any water activities.

Yes

Yes, but inexperienced

Other Information

Please tell us anything else you would like us to know regarding your children! CAMPER PARENTS ONLY (GRADES 5-7): If you have any buddy requests, please list those here. We will do our best to accommodate, but please remember these requests are NOT guaranteed! -- TEENS, this is NOT for you..

ARE YOU 100% FREE OF DRUGS, ALCOHOL, TOBACCO & VAPE USAGE?

Yes

Liability #1

I, as parent/guardian of registered child, do give my permission for Camp GLOW personnel to take my child for medical treatment in an emergency and give permission for treatment in my absence, This will only be in the case I cannot be reached in a reasonable period of time. I also give permission for Camp GLOW personnel to release my child's medical information to medical personnel as necessary. I also understand that I alone am assuming responsibility for providing insurance coverage or must accept responsibility for payment of medical services if they are needed by my child.

Liability #2

By my electronic signature below, I give my child permission to participate in CAMP GLOW, Inc. I certify that I am the parent or legal guardian of the child named above. Further, by submitting signed paperwork or by typing my signature below and submitting this paperwork electronically, I agree to and do hereby waive any claim which should or could arise as a result of any injury to any person or property as a result of my child’s participation in CAMP GLOW, Inc. I agree to hold harmless the director, officers, agents and volunteers of CAMP GLOW for any such injuries. I recognize that my child will be participating in events possibly including but not limited to: swimming, canoeing, paddle boarding, running, hiking, walking, fishing, cooperative games, relays, games, dancing, sports, volleyball, basketball, water slide, zip line, climbing wall, tennis, basketball, kayaking, crafts, and soccer among other events and that injuries are a possibility from participation from any of the events. I also understand that my child may be transported by car, truck, golf cart or other motorized vehicle while at CAMP GLOW, Inc. By my electronic signature or signature below, I agree and understand that the supervisors of my child will take reasonable steps to provide a safe environment for my child but I recognize that neither CAMP GLOW, Inc. nor any agent or volunteer thereof guarantees the safety of my child in any way.

Liability #3

By my electronic signature below, I understand that I/my child may be photographed at CAMP GLOW and I give permission for these photographs to be published in local or national media for CAMP GLOW use. By signing below, I do permit and authorize CAMP GLOW agents, and volunteers who are acting on their behalf to use the photograph(s) for purposes related to the mission of CAMP GLOW including publicity, marketing, and promotion of CAMP GLOW. I understand that photographs may be edited, copied and distributed by means of various media, including video presentations, television, news bulletins, mail outs, billboards or signs, brochures, placement on websites, newspapers or social media. I understand that, although CAMP GLOW will endeavor to use photographs in accordance with standards of good judgment, they cannot guarantee that any further dissemination of photographs will be subject to their supervision or control. Accordingly, I release CAMP GLOW, Inc. from any and all liability related to dissemination of photographs and videos.

Liability #4

By my electronic signature below, I further understand and agree that I will be responsible for delivering my child to CAMP GLOW and for picking up my child at the conclusion of the Camp. My child and I agree that my child will follow all rules described to my child by Camp Leaders and that failure to follow any rule can and will result in dismissal of the child from CAMP GLOW, Inc.

How did you hear about us?

Social Media

Website

Reference

Attended Camp GLOW before!

CAMP TEKOA RELEASE OF LIABILITY

Agreement to Participate: I understand the program goals and agree to participate in the programs and activities to the best of my ability. I agree and hereby state that I am aware and understand that all of the activities are strictly voluntary and it is my own choice to participate in each activity to whatever degree I deem appropriate and after due consideration of my own physical health, physical abilities and medical conditions. I have informed the Director of Camp Tekoa and/or the leader of the event of any medical conditions I may have. I further state that in choosing to participate I am not under the influence of any chemical substance including alcohol. Medical and Liability Release: I willingly and knowingly assume for myself, my heirs, family members, executors, administrations and assigns all risk of physical injury and sickness and emotional upset which may occur during or after participating in any aspect of this event and hereby agree to hold Camp Tekoa its employees, instructors, facilitators, Board members and agents harmless for any liability arising out of my participation in the event. I hereby give permission to the Camp Tekoa parties and to contact emergency services for help, whether or not the Camp Tekoa parties have contacted my emergency contact, and give my permission to a licensed physician or other licensed medical provider to provide proper treatment, including but not limited to hospitalization, injection, anesthesia and/or surgery. I hereby RELEASE, WAIVE AND FOREVER DISCHARGE Camp Tekoa from any and all claims, liabilities , causes of action, damages demands, judgments, executions, liens and costs whatsoever in law or equity, including, without limitation, liability for death or bodily injuries to any person or damage to any property resulting from any (1) claims made against medical providers of emergency services under this authorization, or (2) against the Camp Tekoa Parties for obtaining emergency medical series for me pursuant to this authorization and waiver.