CAMP WINIWACA 2018 REGISTRATION

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Fill out application below

Student's Name *
Student's Name
Student's Phone Number *
Student's Phone Number
Address
Address
Gender *
Special conditions or medication? *
Any allergies (food, medicine, etc.)? *
Parent / Guardian Name *
Parent / Guardian Name
Parent / Guardian Address *
Parent / Guardian Address
Parent / Guardian Phone Number *
Parent / Guardian Phone Number
I understand at camp my student will participate in activities that are not limited to lakefront blob, canoes, paddleboards, fishing, hiking, rock climbing, zip lines, ropes course, archery, contact sports, and camp fire activities. I do not hold First Baptist Church Athens, Texas or Forest Glen Camps liable for injuries my student may incur. My student also agrees to follow the rules of conduct and direction given to me by any of the adult leaders of camp. He/she and myself understands that if he/she chooses not to follow any rules of conduct and/or directions given to him/her by any leader of camp that he/she will be sent home without a refund. If he/she brings or participates in any illegal activity (drugs/alcohol) he/she and myself understands that the police will be call first and then my parents will be notified. *
Insurance Information
Phone
Phone
I hereby authorize my student to obtain medical care and services as well as hospitalization, if necessary, and that he/she will be taken to a local hospital and will be attended by a physician on call there. (NEED COPY of Card if available, email to jorge@authenticyouth.com) *
Other Emergency Contacts if Parent / Guardian is not available
Emergency Contact 1
Emergency Contact 1
Emergency Contact 1 Phone Number
Emergency Contact 1 Phone Number
Emergency Contact 2
Emergency Contact 2
Emergency Contact 2 Phone Number
Emergency Contact 2 Phone Number

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