Leadership, Music & Speech Registration



June 11th - 16th, 2012 -Ron DeGarde & Layton Talber

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

Camper Information
Camper's Full Name:
  M F
Street Address:
City, State & Zip: ,   
Phone Number: -
Email Address:
Grade you 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:


Your Talents
Please Choose 1 Track:    Music    Speech    Leadership

 
I choose the Music Track:
Please choose 1: Vocal
Brass
Percussion 		String
Woodwind
Keyboard
Please list the instrument that you play and how long you've been playing.
I choose the Speech Track:
Please choose 1: Reader's Theater Choric Reading
I choose the Leadership Track:
Please choose 1: Christian Leadership Preaching


Medical Information
Medications:

Reason for Medication:
Allergies: Antibiotic Ointment Asthma
Bee Stings Penicillin None
Other Allergies:
Physical Problems or Limitations:
Personal Physician:
Physician Phone Number: -
Insurance Company:
Policy Number:
Policy Holder:
Date of Last Tetanus Shot:


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.