Camper Application Form

Complete the application form online (below) or download a pdf form to complete and mail: Mount Jubilee Ministries, PO Box 81, Reidsville, NC 27323

DOWNLOAD PDF FORM

Total Camp Cost: $350 ($300 + $50 deposit)

$50 deposit due with completed application

$300 balance due by July 1, 2020

Payments may be made online with the prompt at the bottom of application or checks may be made payable to Mount Jubilee Ministries and mailed to: 

Mount Jubilee Ministries
PO Box 81, Reidsville, NC 27323

Scholarship assistance is the responsibility of Camper Families. MJM recommends First in Families of North Carolina (http://fifnc.org) as an option. Once all scholarship opportunities have been exhausted unsuccessfully, please contact Cecil Cottrell

For questions please contact: 

Candice Hughes, Program Director at [email protected] 

Cecil Cottrell, Executive Director at [email protected]

GENERAL INFORMATION

  • Date Format: MM slash DD slash YYYY
  • 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

  • Date Format: MM slash DD slash YYYY
  • 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!
  • Date Format: MM slash DD slash YYYY
  • 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 July 1, 2020. $50.00 deposit and a completed application form is required to reserve camper’s spot!

    Mail completed application & balance of fee by July 1, 2020 to: Camp Jubilee PO Box 81 Reidsville, NC 27323

    Contact Information

    For further information or questions contact:

    Candice Hughes, Program Director [email protected]

    Cecil Cottrell, MJM Executive Director [email protected]

    Scholarship assistance is the responsibility of Camper Families. MJM recommends First in Families of North Carolina (http://fifnc.org) as one option. Once all scholarship opportunities have been exhausted unsuccessfully, please contact Cecil Cottrell.

Scholarship assistance is the responsibility of Camper Families. MJM recommends First in Families of North Carolina  (http://fifnc.org) as one option. Once all scholarship opportunities have been exhausted unsuccessfully, please contact Cecil Cottrell.

For questions please contact: 

Candice Hughes, Program Director at [email protected] 

Cecil Cottrell, Executive Director at [email protected]