2019 Family Camp Registration

Address *

Email *
example@example.com
Alternative Email
example@example.com
Primary Phone Number *

- Area Code Phone Number
Alternative Phone Number

- Area Code Phone Number
Emergency Information

If you or your child(ren) should require medical attention at camp for injuries or illness contracted prior to coming to camp, the following information will be necessary to provide proper medical service.
Do you have medical insurance? *

yes no
Name of Insured
Insurance Company
Policy Number
Family Doctor
Additional Information
Medical Information
Does anyone in your family have any prior or current medical conditions? *

yes no
Please tell us the name(s) and the medical conditions they have.
Does anyone in your family have any food allergies/dietary restrictions? *

yes no
What food allergies/dietary restrictions do your family member(s) have?
Does anyone in your family have any drug allergies? *

yes no
Please tell us the name(s) and the drug allergies your family member(s) have.
Is there anyone in your family currently taking any medications? *

yes no
Please tell us the name(s) and the current medications your family member(s) are taking.
Is there anyone in your family that have any activity restrictions? *

yes no
Please tell us the name(s) and the activity restrictions your family member(s) have.
Housing Preferences
Housing Preference-Choice 1
Housing Preference-Choice 2

2019 Family Camp Registration Form