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CAMPER REGISTRATION
Gaurdian First name
Gaurdian Last name
Email
Address
Phone
Campers Name
Shirt Size
Camper DOB
Sex
Medical Insurance Carrier
Policy Holder Name
Policy Number
Ins Phone #
Life Jaket Required for Your Child
Medications
NAME
Dose
NAME
Dose
NAME
Dose
Name
Dose
Name
Dose
Allergies
Allergies
Additional Commits
NOTE: Lighthouse Baptist Church is required by law to protect your child’s disclosed health/medical information. This information will only be used to dispense medications or treatment if needed. This information will also be kept confidential and will only be disclosed to Camp Director, Child’s Counselor and any Medical Personnel as needed. At the end of Camp this information will be destroyed to protect your privacy.
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Thanks for registering to our event. See you there!
Camp Due Payment
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