June 14-19, 2010

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

Camper Information

Adult's Full Name:
	M F
Street Address:
City, State & Zip:	,
Phone Number:	-
Email Address:
Second Adult's Name:
Child 1 Name and Age:
Child 2 Name and Age:
Child 3 Name and Age:
Child 4 Name and Age:
Child 5 Name and Age:
Child 6 Name and Age:
Child 7 Name and Age:
Child 8 Name and Age:

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.