2019 TCBA Leader Application
Training dates: May 6, 2019 6:30 North Nixa Baptist Church 1730 N. State Hwy CC
(background check forms will be filled out and submitted)
June 2, 2019 6:30 pm Baptist Hill Assembly 9519 State Hwy V, Mt Vernon
CAMPER LEADER APPLICATION
Your Email Address *
Your answer
First Name *
Your answer
Last Name *
Your answer
Assignments *
What is your preference?
Required
Gender *
Church attending Camp with *
Your answer
T shirt size *
Date of Birth *
MM
/
DD
/
YYYY
Home phone *
Your answer
Cell phone *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Work Phone
Your answer
Medical Conditions *
Are you under a doctor's care at present?
If so for what?
Your answer
Doctor's Name
Your answer
City, State
Your answer
Do you have health insurance?
Company
Your answer
Will you be taking medication at the time of camp?
List all medications
If yes, please list all medications
List all medications
Your answer
Allergies to food or medication? *
Please list all known allergies
Your answer
Do you have any physical disabilities that would keep you from active sports participation? *
If yes, please list them:
Your answer
Emergency Contact *
Please give name, relationship, and phone number of individual(s) to contact in the event of an emergency, if a parent or guardian cannot be reached.
Your answer
DIRECTORS, BIBLE TEACHERS, CAMP PASTOR OR WORSHIP LEADERS ONLY: Children coming with you (not as a camper)
List Name, Age & Female or Male
Your answer
PERMISSION-DO YOU GIVE CONSENT? *
By submitting this form you will be giving your permission for TCBA Camp Staff to seek emergency medical treatment if necessary. Submission of this form further gives TCBA Camp nurse permission to administer first aid to you as necessary during the week of June 2-6, 2019. *Junior Cabin Leader PARENTS/GUARDIANS: Your signature also gives permission for TCBA Camp Staff to seek emergency medical treatment if needed for your minor child while at camp.
Submit
Never submit passwords through Google Forms.
This form was created inside of Tri County Southern Baptist Association. Report Abuse - Terms of Service