Camper
Registration
Church
Name_______________________________________Town____________________________________State_____
Name_____________________________________________________________________
Permanent
Address: Box/Street Address_____________________________Town______________________
State________zip______________Phone___________________________e-mail__________________________
Date
of Birth________________Height_________Weight_________Sex_________Marital
status______________
(For
those 17 years and under complete this section)
Parents
Name______________________________________________________________________________________
Phone
Number_________________________________________e-mail_________________________________
Emergency/Medical
Information:
Person
to be contacted in an emergency_______________________________Relationship___________________
Address_____________________________________________________________Phone______________________
Are
you allergic to any medications? _____No _____Yes. If yes, list
those drugs________________________________________
List
other allergies ___________________________________________________________________________________________
List
any medications presently taking____________________________________________________________________________
List
any special physical limitations _____________________________________________________________________________