Camper Information

Camper's Full Name:
	M F
Street Address:
City, State & Zip:	,
Phone Number: (area code) - 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: (area code) - number	-
Church's Email Address:

Authorize Medical Statement

I give Camp Joy my consent to secure any necessary medical treatment for my child 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 child. Please Note: Please do not send any medications unless prescribed by a healthcare provider. All medication needs to be in the original medication containers. Please send one extra day’s medicine for the week. Non-prescription medicine should not be brought to camp. If any person in your family has a medical condition that the camp nurse should know about, please include a note. For patients with asthma, please send a written asthmatic plan or doctor’s directive so that the nurses and counselors know how to help the camper participate as fully as possible and still manage his asthma.
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.