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Winter Youth Camps Online Registration | ||||
| Camper Name | ||||
| Mailing Address |
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| City | State Zip | |||
| E-Mail Address | ||||
| D.O.B.(MMDDYY) | Grade Sex | |||
| Home Phone |
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| Father's Name | ||||
| Father's Work Phone | cell | |||
| Mother's Name | ||||
| Mother's Work Phone | cell | |||
| Church You Attend | ||||
| Roommate Preference | ||||
Payment Information:
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NAME OF ADULTS AUTHORIZED TO PICK UP YOUR CHILD: |
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| Sugar Pine Christian Camps will release your child only to adults listed below. | ||||
Emergency Information |
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| If you child should require medical attention at camp for injuries or illness contracted prior to coming to camp, the following information will be necessary to give your child proper medical service. | ||||
| Do you have insurance? | ||||
| Insurance Company | ||||
| Policy Number | ||||
| Name of Insured | ||||
| Family Doctor | ||||
Health History |
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| Drug Alergies | Chronic Asthma | Handicaps | |
| Food Alergies | Hay Fever | Diabetes | Frequent Colds |
| Other Alergies | Stomach Upset | Epilepsy | Insect Stings |
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If any of the above are checked, please provide details, including normal treatment. |
Date of last Tetanus Shot (MMYY) |
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Name and Dosage of any medication that must be taken. |
Any activity restrictions?
If yes, please explain |
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| Please explain any special needs. |
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In order to complete registration please print out our medical release form by clicking the "Medical Release Form" below fill out and sign the form and fax it to us at 559 683 4910 |
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