Camper Registration Form

Complete the registration form online (below) or download a pdf form to complete and mail in. DOWNLOAD PDF FORM
Camp Cost: $300 ($275 + $25 registration)
Registration fee of $25 with a completed application will reserve your spot.
Maximum of 50 campers.

Final payment and full application must be received by June 1, 2018.

Scholarship information available upon request.

Please make checks payable to:
Mount Jubilee Ministries
PO Box 81 Reidsville, NC 27323




Special note: Be sure that an adequate number of medications are sent in the original prescription containers, with the camper’s name and instructions on the bottle. Be sure that the dosage on this application and on the bottles are the same. It is helpful if we know when you give the medicine; for example, mealtimes, bedtime, etc. This information is very important so we can adapt to special needs when we are aware of them. Medications are to be put in a separate bag, marked “Nurse.” Please do not give campers their own bottles of aspirin, cough syrup, etc.

For the safety of all Camp Jubilee participants, all campers and staff will be checked for lice at registration.


I give my permission for any medical treatment necessary for the camper’s health and well-being.

NOTE: Please provide copy of all insurance/Medicaid/Medicare ID card(s)


During this week, many pictures and videos will be taken for the campers to enjoy. These photos may also be used in promotional presentations of Camp Jubilee. Be assured that the pictures will not be sold, solicited, defamed, or used in any way that would knowingly bring harm or shame to anyone.

My camper has permission to travel with authorized personnel affiliated with Mount Jubilee Ministries, Inc. This permission includes trips to and from activities in the camp schedule and any necessary transportation for the well-being of my camper. Personnel will transport my camper in a safe vehicle with a licensed, adult driver and adequate supervision.
Please fill in camper’s name and sign to authorize.

COST: $300 ($275 + $25 Deposit) due June 1.
$25.00 deposit and a completed registration form required to reserve camper’s spot!

Mail completed application & balance of fee by June 1 to:
Camp Jubilee
PO Box 81
Reidsville, NC 27323

For further information or questions contact:

David Cullen, Camp Jubilee Director
(336) 609-4565

Cecil Cottrell, MJM Executive Director
(336) 552-3766

Scholarship information available upon request.

Online Camp payment option is now available!

Total Cost is $300 or a $25 deposit will hold your camper's reservation with an additional $275 due by June 1.