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Midway
Christian Camps Registration |
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And Medical Form |
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Primary Camp - July 4-8 Ages 5-7
$40.00
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Junior Camp - July 4-8 Ages 8-11
$40.00
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Teen Camp - July 11-15 Ages 12-18
$40.00
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Camper's Name |
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Social Security Number |
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Boy or Girl |
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Birthdate |
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Age |
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Which Camp? |
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Home Address |
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City,St,Zip |
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Emergency Phone Number |
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2nd Emergency Phone |
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Pastor and Church |
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Pastor's Phone Number |
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Family Doctor |
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Family Doctor's Phone |
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Medications |
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Allergies |
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Medical Problems |
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Parents must sign the following
statement: |
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You have my permission to
administer any first aid or health related services that my child may need. |
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Signed |
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Date |
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Please
print and mail as soon as possible to help us plan: |
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Pastor Richard Owen |
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Church - 540.943.1678 |
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Pastor 540.943.3064 |
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