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Please Choose a Camp or Event:
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| If you chose the music camp, you must complete the section at the bottom of this form |
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First Name
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Last Name
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Home Address
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City
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Province or State
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Postal Code
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Home Phone
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Bus Phone
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Cell Phone
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Email
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Male Female
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Birth Year
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Birth Month
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Birth Day
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Camper Lives with 1 or both parents |
One
Two |
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Home Church
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Church Address
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Pastor's Name
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Person Authorized to pick up Camper
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Relationship to Camper
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Roommate Requested
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I Agree to all the terms |
Yes
No |
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| Medical Information |
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Camper's Full Name
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Ontario Health Card Number
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Emergency Contact Person
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Relationship to Camper
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Phone #
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Physician's Name
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Physician
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Physician's Number
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List any allergies
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List Any Medication brought?
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May Tylenol or Aspirin be Given?
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Date of Last Tetanus
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include the dosage of Ritalin
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Any Comments?
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Memories Flash Video ordered? |
Yes
No |
Would you like to order a T Shirt |
Yes
No |
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Instrument |
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Choose one of the following |
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I Have My Own Instrument |
Yes
No |
Level |
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