Junior Wilderness Camp Registration



July 19th - 24th, 2010

 

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 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.