Camp Application 2021 View Our Covid-19 Policy Session * —Please choose an option—May 30 Deland GuthrieJune 6 Westley HazelJune 13 Ronnie WestJune 20 Riley NelsonJuly 11 Jason RidgewayJuly 18 Doug Frazier Registration Options * —Please choose an option—1st Child In Family To Register2nd Child In Family To Register3rd + Child In Family To RegisterDay Camper Camper Name * Age * Gender * —Please choose an option—MaleFemale Shirt Size * Nickname Date of Birth * Grade in School* Address * City/State/Zip * , Member? —Please choose an option—YesNo Church Affiliation Parent(s) Name * Phone Number * E-mail * Member(s) Church Affiliation Medical/Other Upload A Copy of the Camper's Insurance Card Medications? * —Please choose an option—YesNo Please List Any Medical/Dietary Restrictions * Camper's Doctor * Doctor's Phone * Date of Last Physical * My Child is Subject to: (Select all that apply) Allergy to Medicine, Food, Plant, Insect or Animal ToxinA condition that requires a special dietA condition that requires a physician's careA condition that requires medicationAsthmaConvulsionsHeart TroubleDenturesDiabetesContact LensesBleeding DisordersFainting Spells Can Camper Swim? * —Please choose an option—YesNo Is the camper prohibited from any activities? Comments Δ
