College and Career Registration Form
Camp for those who are 18+
Name
First Name
Last Name
E-mail
example@example.com
Cell Number
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State
Zip Code
Additional Comments
Back
Next
Health Form
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Biological Sex
Please Select
Female
Male
Emergency Contact
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Medications
Those you will take at camp
Enter medications and times taken
Allergies
Food Allergies
*
Please Select
Yes
No
List Food Allergies below
Medicine Allergies
*
Please Select
Yes
No
List Allergies to Medicine Below
Known risk of Anaphylactic Allergic Reaction?
*
Please Select
Yes
No
List of known Allergies and Explanation of reactions.
General Medical Information
Things camp staff should know...
For example health history, recent medical changes, important things to be aware of...
Any activities that you should not participate in?
Medical and Photo Release
I consent to medical attention by the Baptist Youth Camp staff and should it be necessary other health care providers. By typing my name below I give permission to receive medical care as well as permission to be photographed for camp materials.
Signature
Continue
Continue
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