APPLICATION
CONSELOR_______________________
CAMPER ATTENDS CHURH AT_____________
CAMP
APPLICATION
NAME_______________________________________________________
ADDRESS____________________________________________________
CITY________________________STATE____________ZIP__________
PHONE______________________BIRTHDAY_____________________
MALE____FEMALE____AGE____BANQUET RESERVATION_____
In order to serve you better, please provide the following
information.
Is this camper covered by medical insurance yes______no_________
Filing address ________________________________________
City_________________________State____________Zip_____
Sign here for medical aid________________________________
Parent or guardian signature
I am aware that my child is bringing prescription medication
to camp.
I will inform the counselor of said prescription &
acknowledge that my
Child is responsible for taking it as prescribed.
_____________________________________________________________
Parent or Guardian signature
Emergency
phone(______)______________________________________
Cell phone
(_____)_____________________________________________
Called only in case of emergency