Junior Camp One Registration



June 21th - 26th, 2010


Please do not press tab or enter while filing out registration form. Thank you.

 

Please Note: Do not press tab while filling out this registration form.

 

Camper Information

Camper's Full Name:  
  M F
Street Address:  
City, State & Zip:   ,   
Phone Number: (###) - ###-####   -
Email Address:  
Grade camper just finished:  
Birthdate: ##/##/##  
Parent's Name:  
Roommate Request:  

Church Information
Church:  
Pastor's Name:  
Church's Street Address:  
City, State & Zip:   ,   
Church Phone Number: (###) - ###-####   -
Church's Email Address:  


Authorize Medical Statement
I give Camp Joy my consent to secure any necessary medical treatment for my family during the camp period. I also authorize any qualified physician to render treatment he or she deems necessary upon consultation with the camp staff. I authorize over-the-counter medication to be provided by the healthcare staff. I realize my insurance will be billed for any medical treatment as the primary coverage for my family.
I authorize:  
Today's Date:  
When the registration process is completed, please print off the medical statement and have
it signed by a parent or gaurdian. It must accompany each camper at the time of registration.
Thank you.

You will receive an email conformation after this step.