ChildrensCampRegistration

WEBSTER COUNTY BAPTIST ASSOCIATION

CHILDREN'S CAMP REGISTRATION

E-mail:

Campers First Name:

Campers Last Name:

Gender

Last Grade Completed

Third (3)
Fourth (4)
Fifth (5)

Birthdate

Parent/Guardian's First Name

Parent/Guardian's Second Name

Phone Number

Address

City

State

Zip

Parent/Guardian's Email

Secondary Contact

Secondary Contact Phone Number

Where Do You Attend Church?

OTHER CHURCH

Shirt Size of Child?

Doctor's Name

Preferred Hospital

Insurance Name

Insurance Card Holder's Name & Group Number

Allergies

Medications

Other Information We May Need to Know

Check word:

I understand that my child will be under the supervision of camp staff volunteers, a certified lifeguard and a certified medical professional (CNA, LPN or RN) while at camp consent to the known conditions of camp which involve outdoor recreation, swimming, riding associational/church sponsored transportation (if desired) and staying overnight in cabins. As the parent or legal guardian, I remain fully responsible for any legal, financial or medical responsibility which may result from personal actions taken by my child. Understanding the above, my child has permission to participate in the Webster County Baptist Association's Summer Camp.

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