TTTC Senior Camp 2025 Application

Doctor's Name*

First NameLast Name

Doctor's Phone*

Please enter a valid phone number.Format: (000) 000-0000.

Name of Insurance company*

Insurance's Phone*

Please enter a valid phone number.Format: (000) 000-0000.

Group or policy number*

Personal ID number*

Date the camper last saw a physician*

Date

Reason*

Date and physician seen for camper’s last physical examination*

Date

Date of last tetanus shot*

Date

Please give any information that will be helpful in providing routine or emergency care for the camper

I have had the Consent and Release of Liability form notarized*

Upload Form Here

If you have trouble uploading, please email to trailtothecross@gmail.com.

I have enclosed a copy of my insurance card*

Upload a copy of your insurance card here

Signature (please sign below)

My Products*

TTTC Senior Camp 2025 (Full payment)

Registration for the TTTC Senior Camp 2025 Summer Program

$250.00

TTTC Senior Camp 2025 ($100 DEPOSIT ONLY)

Registration for the TTTC Junior Camp 2024 Summer Program - ($100 Deposit, remainder due before event)

$100.00

Enter coupon

Total

$0.00

Please enter your zipcode in the last entry box

HEALTH RECORD AND RELEASE