Midway Christian Camps Registration

 

 

And Medical Form

 

 

 

 

 

 

 

 

Primary & Junior Camp - July 3-7 Ages 5-11 $50.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Camper's Name

 

 

 

Social Security Number

 

 

 

Boy or Girl

 

 

 

Birthdate

 

 

 

Age

 

 

 

Which Camp?

 

 

 

Home Address

 

 

 

City,St,Zip

 

 

 

 

 

Emergency Phone Number

 

 

 

2nd Emergency Phone

 

 

 

Pastor and Church

 

 

 

Pastor's Phone Number

 

 

 

Family Doctor

 

 

 

Family Doctor's Phone

 

 

 

Medications

 

 

 

Allergies

 

 

 

Medical Problems

 

 

 

 

 

 

 

 

 

Parents must sign the following statement:

 

 

 

 

 

 

 

You have my permission to administer any first aid or health related services that my child may need.

 

 

 

 

 

 

 

Signed

 

Date

 

 

 

 

 

 

 

 

 

 

Please print and mail as soon as possible to help us plan:

 

 

 

 

Midway Bible Baptist Church

 

 

 

 

 

29 Midway Lane

 

 

 

 

 

Fishersville, VA 22939

 

 

 

 

 

Pastor Richard Owen

 

 

 

 

 

Pastor 540.943.3064