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Midway Christian
Camps Registration |
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And Medical Form |
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Primary, Junior and Teen Camp – July 3rd thru 6th 2023 |
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Camper's Name |
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Social Security
Number |
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Boy or Girl |
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Birthdate |
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Age |
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Which Camp? |
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Home Address |
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City,St,Zip |
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Emergency Phone
Number |
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2nd Emergency Phone |
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Pastor and Church |
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Pastor's Phone Number |
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Family Doctor |
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Family Doctor's Phone |
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Medications |
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Allergies |
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Medical Problems |
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Parents must sign the
following statement: |
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You have my
permission to administer any first aid or health related services that my
child may need. |
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Signed |
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Date |
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Please print and mail
as soon as possible to help us plan: |
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Pastor Richard Owen |
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540.943.3064 |
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