TTTC Senior Camp 2024 Application
June 5 – June 8, 2024 CAMPER REGISTRATION
Email
*
example@example.com
Name
*
First Name
Last Name
Age
*
Date of birth
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone
*
Please enter a valid phone number.
Emergency Phone
*
Please enter a valid phone number.
Sex
*
Male
Female
T-shirt Size (Adult)
S
M
L
XL
Other
Parent or Legal Guardian
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Address of Parent or Guardian (if different)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Check one event: When signing up for barrel racing we ask that you be able to walk, trot and lope circles both directions
*
Bull Riding
Bareback Bronc Riding
Barrel Racing
Team Roping
Breakaway Roping
Goat Tying
Trick Roping (No horse needed)
Horsemanship 1 or 2
Chute Dogging
Check one event: When signing up for barrel racing we ask that you be able to walk, trot and lope circles both directions
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HEALTH RECORD AND RELEASE
Note to parents: Every precaution will be taken to ensure that your child’s stay with us is a fun and safe experience. Occasionally, people do get hurt. We require that you have INDIVIDUAL HEALTH INSURANCE to protect your child. In case of sickness or accident, please fill out the following health information completely and accurately for our camp records.
Doctor's Name
*
First Name
Last Name
Doctor's Phone
*
Please enter a valid phone number.
Name of Insurance company
*
Insurance's Phone
*
Please enter a valid phone number.
Group or policy number
*
Personal ID number
*
Date the camper last saw a physician
*
-
Month
-
Day
Year
Date
Reason
*
Date and physician seen for camper’s last physical examination
*
-
Month
-
Day
Year
Date
Date of last tetanus shot
*
-
Month
-
Day
Year
Date
Check any allergies or illnesses:
*
Hay Fever
Poison Ivy
Insect Sting
Penicillin
Asthma
Diabetes
Heart problems
None
Please give any information that will be helpful in providing routine or emergency care for the camper
PARENT / GUARDIAN CHECKLIST - (please initial each item)
I have had the Consent and Release of Liability form notarized
*
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I have enclosed a copy of my insurance card
*
Upload a copy of your insurance card here
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of
I understand that my child is NOT to bring a cell phone or ANY ELECTRONIC DEVICE to camp. If he / she does, I know that the device will be kept by TrailTo The Cross, returned on the last day, and no liability for the device will be accepted by Trail To The Cross
Please mail to: Trail to the Cross - PO Box 853 - Salem, MO 65560For information, contact: Esther Clancy - 573-261-0087 or Kailee Smith 573-889-7278
Signature (please sign below)
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TTTC Senior Camp 2024
Registration for the TTTC Senior Camp 2024 Summer Program
$
250.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Please enter your zipcode in the last entry box
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