Camper Registration Form

Complete the registration form online (below) or download a pdf form to complete and mail in. DOWNLOAD PDF FORM
Camp Cost: $350 ($300 + $50 registration)
Registration fee of $50 with a completed application will reserve your spot.
Maximum of 48 campers.

Final payment and full application must be received by May 15, 2019.

Scholarship information available upon request.

You can pay online using the link at the bottom of the page or, if paying by check, please make checks payable to:
Mount Jubilee Ministries
PO Box 81 Reidsville, NC 27323 

GENERAL INFORMATION

  • Daily Care Information

  • Medical Information

  • 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.
  • Lice Check


    For the safety of all Camp Jubilee participants, all campers and staff will be checked for lice at registration. *NOTE: Typing your initials will be treated as your signature and is binding!
  • Insurance Information

  • Permission:

    I give my permission for any medical treatment necessary for the camper’s health and well-being. *NOTE: Typing your name will be treated as your signature and is binding!
  • Insurance Cards

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

  • Photo Release

    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.
  • *NOTE: Typing your name will be treated as your signature and is binding!
  • Permission to Travel

    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. *NOTE: Typing your name will be treated as your signature and is binding!
  • Registration Information


    COST: $350 ($300 + $50 Deposit) due May 15, 2019. $50.00 deposit and a completed registration form is required to reserve camper’s spot!

    Mail completed application & balance of fee by May 15, 2019 to: Camp Jubilee PO Box 81 Reidsville, NC 27323

    Contact Information

    For further information or questions contact:

    Hannah Yount, Camp Jubilee Director (336) 552-5820 hyountmjm@gmail.com

    Cecil Cottrell, MJM Executive Director (336) 552-3766 MountJubileeMinistries@gmail.com

    Scholarship information available upon request.

Online Camp payment option is now available!

Total Cost is $350 or a $50 deposit will hold your camper's reservation with an additional $300 due by May 15, 2019.