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Camp Success 2024 Registration


Chesterfield Missionary Baptist Church

Lead Servant Reverend Dr. James R. Matthews

Camp Director: Helen Fountain (843-385-6280) 

Camp Assistant Director: Jarvis Wilson (843) 503-1475

8:00 AM - 1:00 PM   Monday, June 10 — Friday, August 2, 2024

Please answer the following information about yourself


Please answer ALL the following information for each child.
You may use this application for 1, 2, or 3 children who live in the same household


Child 1

Child 2

Child 3

Youth Activity Safety and Notification

  • I will attend Chesterfield Missionary Baptist Church Camp Success 2024 Parent’s Orientation on Wednesday, May 22, 2024, at 6:00 PM in the Fellowship Hall.

  • I hereby give approval for my child (children) to participate in Chesterfield Missionary Baptist Church Camp Success activities from June 10, 2024, through August 2, 2024. I also permit CMBC Camp Success to provide transportation for my child (children) to all activities.

  • I hereby release Chesterfield Missionary Baptist Church Camp Success and all personnel from any responsibilities for accidents or injuries resulting from any negligent act of my child (children).

  • I hereby permit Chesterfield Missionary Baptist Church Camp Success to transport my child (children) to the nearest medical facility in case of an emergency.

  • Emergency Medical Release: If an emergency occurs and I cannot be contacted, I authorize the Camp Success staff permission for my child to receive emergency medical treatment.

Thanks for registering. See you there!

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