(865) 376-2236         

To register by mail, CLICK HERE to print registration form.

Fill in entire registration for each child.

PART 1 - Camper Information

*Camper's Name:

Nickname (if preferred) :

*Birthdate: *Age:

Gender:

*Rising Grade in Fall:

School:

Camper Email:

*T-Shirt Size:

Roommate Request (ONE NAME ONLY):
(We will honor 1 mutual roommate request per child. Once 2 children request each other neither can be requested by another child. )


My child swims:

Has your child attended Summer Camp at John Knox before?
Other JKC event attended:

Is this your child's first extended stay away from home?

Please tell us if there has been any life changing event in the past year for your family:

What would you like your child to gain from their camp experience?


$40.00 Registration Fee per camp session is required to reserve your child's space. Spaces may not be reserved by phone or without the non-refundable registration fee which is included in camp pricing.

Realizing that families have different abilities and resources to pay for summer camp, John Knox Center offers a voluntary three-tiered pricing program. You may choose the tier that is most suitable for your family. It is a "free-will" system; you pick the level that is comfortable and affordable for you.

Our goal is to continue to provide Christ centered programming in a safe, welcoming and fun environment, while offering opportunities for partnership for those who value this ministry and wish to help preserve John Knox Center for generations to come.

  • Tier I - This is the lowest rate and is the subsidized rate John Knox Center has historically offered. This price does not reflect what it costs for a camper to attend summer camp.
  • Tier II - This is a partially subsidized rate for families who wish to pay a little more and help support the John Knox Center ministry, but cannot afford the full price of camp.
  • Tier III - This rate most closely reflects what it costs for a camper to attend summer camp at John Knox Center, including facility upkeep and maintenance, staffing, utilities, and equipment.



*Camp
Ages
Date
Tier I Cost
Tier II Cost
Tier III Cost


Day Camp #1 (Full)

4 - 10

June 7th - June 11th

$150

$200

$255


Marathon Camp (Full)

Grades 4th - 12th

June 20st - July 2rd

$530

$850

$1230


Night Owl Camp (Full)

Grades 6th - 12th

June 15th - June 18th

$280

$355

$410


Covenant Partners (Full)

16 -18

June 6th - June 16th

$410

$495

$630


Middle School Adventure Camp (No Spots Open! Waitlist Available!)

Grades 5th - 8th

July 7th - July 16st

$565

$715

$915


Native Ways Camp

Grades 4th - 6th

July 11th - July 16th

$340

$490

$615


High School Adventure Camp (No Spots Open! Waitlist Available)

Grades 9th - 12th

July 18th - July 23th

$385

$410

$525


Mini Camp (Full)

Grades 2nd - 4th

June 13th - June 15th

$215

$310

$370


Day Camp #2 (No Spots Open! Waitlist available)

4 - 10

July 5th - July 9th

$150

$200

$255



PART 2 - Family Information

*Camper's Family or Guardian's Name:    *Residential Phone:

*Address:
*City: *State: *Zip:

*Email:

*Family Status: Other or Custody:


Father's Name:

Father's Address if different from above:
City: State: Zip:

Father's Business Phone:

Father's Cell Phone:

Father's Email Address:


Mother's Name:

Mother's Address if different from above:
City: State: Zip:

Mother's Business Phone:

Mother's Cell Phone:

Mother's Email Address:

Email addresses will be used to convey information to parents. Please add us to your email database.


Home Church:

City:


Emergency Contact (NOT LIVING IN THE HOME)

*Name: *Relationship:
*Work Phone: *Home Phone: *Cell Phone:

Second Emergency Contact (NOT LIVING IN THE HOME)

Name: Relationship:
Work Phone: Home Phone: Cell Phone:


*INSURANCE INFORMATION

Company Name: Policy Number:

Please check if you do not have insurance:


Please tell us how you heard about us: Other:


PART 3 - Health History


*To help us help your child succeed at camp, please provide as much information as possible.
(Numbers 1 - 13 are REQUIRED)

*1. Have any symptoms of ADD or ADHD? Yes No
If yes, please explain:

*2. Have any symptoms of learning or emotional disorders? Yes No
If yes, please explain:

*3. Have a chronic or recurring illness/condition (i.e. Psoriasis, constipation, frequent nosebleeds)? Yes No
If yes, please explain:

*4. Prone to swimmer's ear? Yes No
If yes, please explain:

*5. Ever had seizures? Yes No
If yes, please explain:

*6. Ever been diagnosed with a heart condition? Yes No
If yes, please explain:

*7. Ever had back or joint problems? Yes No
If yes, please explain:

*8. Have Diabetes? Yes No
If yes, please explain:

*9. Have asthma / carry an inhaler? Yes No
If yes, please explain:

*10. Have problems with sleep-walking? Yes No
If yes, please explain:

*11. Have a history of bed-wetting? Yes No
If yes, please explain:

*12. Ever had an eating disorder? Yes No
If yes, please explain:

*13. Ever had emotional difficulties for which professional help was sought? Yes No
If yes, please explain:

*List any allergies and treatment given for them:

*Any special dietary needs or additional comments to help your child at camp?

Please give all dates of immunizations:

Vaccine Mo/Yr Mo/Yr Mo/Yr Mo/Yr
Chicken Pox
Hepatitis A
Hepatitis B
Influenza
MMR
Polio
Tetanus/Diphtheria


IMPORTANT:
14 Days before your child's camp session begins: PROOF OF HEALTH EXAM and DATE OF LAST TETANUS SHOT and PAYMENT IN FULL IS DUE! Paperwork may be emailed to admin@johnknoxcenter.org or faxed to 865-376-1719.

The above information can be written on the doctor's form or practice letterhead, or a form for your convenience can be downloaded here.


Please notify the camp if the camper has been exposed to any communicable diseases within three weeks of their camp session.


PART 4 - Financial Information/Parent Authorization

$40.00 Registration Fee per camp session is required to reserve your child's space. Spaces may not be reserved by phone or without the non-refundable registration fee which is included in camp pricing.

Refund Schedule
More than 30 days from start of child's camp session= 100% (minus $40 registration fee)
30 to 15 days from start of child's camp session= 50% (minus $40 registration fee)
14 days or less from start of child's camp session = No refunds

Session(s) Total $

I would like to donate to the Camp Scholarship Fund $

I would like to donate to the Program Fund $

I would like to donate to Capital Improvements $

Church Scholarship (amount to be paid by church) $

*Method of Payment:

*Amount Paying Today: $


Parent Authorization

I hereby give my permission to the Presbytery of East Tennessee/John Knox Center for my minor, child or ward (collectively "minor") to participate in all activities and further agree to the terms herein contained. On behalf of my minor, to participate in John Knox Center (hereinafter collectively referred to as JKC/ PET) activities and to use its equipment and facilities, I agree to release, indemnify, hold harmless, and covenant not to sue JKC/PET, its employees, agents or volunteers for any and all liability, claims, demands, or causes of action which may be brought by myself, my minor, or on behalf of either of us, and which are in any way connected with such use or participation by my minor or myself, whether caused by the negligence of JKC/PET, its employees, agents, or volunteers, or otherwise. I acknowledge my minor's participation in individual and group initiatives, problem solving exercises, high ropes elements, waterskiing, whitewater canoeing and personal growth and development training activities entails known, perceived, and unanticipated risks that could result in serious physical or emotional injury, permanent disability, or death. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity and I expressly accept and assume on behalf of my minor all the risks existing in these activities. I acknowledge my minor's participation in programs may include transportation away form the John Knox Center property. I authorize JKC/PET personnel to transport my child as part of regular program activities.

I authorize JKC/PET personnel to call for medical care or to transport my minor to a medical facility or hospital if, in the opinion of such personnel, medical attention is needed. I agree to pay all costs associated with such medical care and transportation. I hereby give permission to the John Knox Center staff to provide, seek, and consent to routine health care, administration of prescribed medications, and emergency treatment for me/my child/ward, as may be necessary, including, but not limited to, x-rays, routine tests and treatment, and/or hospitalization. I agree to the release of any records necessary for treatment, referral, billing, or insurance purposes. I hereby agree to the disclosure to the John Knox Center staff of the protected health information of the person herein described. I also agree to comply JKC/PET rules and policies and to cooperate with JKC/PET personnel. I understand and agree that if myself or my minor fail to comply with the rules and policies, s/he may be asked to leave the event at the parent or legal guardian's expense, with no refund given for the paid cost of the event. I hereby represent that my minor is in good health, that I have identified all medical conditions applicable to participation, and that I have adequately informed JKC/PET personnel of any special instructions. I certify that I have adequate insurance to cover any injury or damage my minor may suffer while participating, or I agree to bear the costs of such injury or damage myself. I give my permission to allow JKC/PET to use my minor's likeness in photos and in any form of media for publicity and reporting purposes (print, digital, online, etc.). I agree that this release, waiver, and indemnity and other terms herein are intended to be as broad and inclusive as permitted by the law of the State of Tennessee and if any portion is invalid, the remainder shall continue in force.

I have read the above and acknowledge the information stated on this form is complete and correct. By typing my name below, I agree that this is an electronic signature. I understand that an electronic signature is legally binding in Tennessee.

*SIGNATURE: *DATE:


Please verify all information on this page then click FINISH & Pay Now.