Camp WeWoSeJe Camper Registration 2019
This form will be sent to the Camp Registrar and takes place of the paper form.

*In order to save a bed, a non-refundable deposit of at least $25 (per week attending) will need to be sent to:
Camp WeWoSeJe
P.O. Box 17
Texico, IL 62889
*Make checks payable to Camp WeWoSeJe

Be sure to read over the entire Summer Camp Registration Information PDF on the Website for full details.

Camper Name (First, Last) *
Your answer
Gender of Camper *
Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Parent/Guardian Name *
Your answer
Phone Number (Primary) *
Your answer
Please provide any additional phone numbers we may need to contact a guardian. *
Your answer
Name of Emergency Contact (Other than Guardian) *
Your answer
Phone Number of Emergency Contact *
Your answer
Relationship of Emergency Contact to Camper *
Your answer
Camper Grade in Fall 2019 *
Camper Birth Date *
Your answer
Age *
Your answer
Are you a first time camper? *
Church you attend (if applicable)
Your answer
If possible, I would like to be in the same cabin as...
Your answer
Did you bring any first time campers? If so, who? *
Your answer
Which camp(s) will you be attending? Note: Grade is as of Fall 2019* *
Required
Confidential Medical Information:
Do you carry family medical/hospital insurance *
Name of Responsible Party
Your answer
Address
Your answer
Phone Number
Your answer
Relationship to Camper
Your answer
Name of Family Physician *
Your answer
Date of Last Tetanus Shot *
MM
/
DD
/
YYYY
Are all immunizations up to date? (If No, explain why) *
Your answer
Has the camper been exposed within the last three weeks to any kind of communicable disease? *
Please list any allergies relating to food: *
Your answer
Please list any other allergies: *
Your answer
List all medications the camper will require while at camp along with a reason for taking the medicine (Medications must be in originally labeled container) *
Your answer
General Health History: If yes, please explain in the next question field. Has/does the Camper: *
Yes
No
Every been hospitalized?
Ever had surgery?
Have recurrent/chronic illness?
Had a recent infection disease?
Had a recent injury?
Had asthma/shortness of breath?
Have diabetes?
Had seizures?
Had headaches?
Wear glasses, contacts?
Had fainting or dizzy spells?
Passed/had chest pain?
Had "mono" in the last 12 months?
Have sleep problems?
Ever had back/joint problems?
Have skin problems?
Explanation of above questions answered "Yes"
Your answer
Read the following carefully:
If there is an exception to the use of a generic, over-the-counter medication on the camper, please list below:
Your answer
(Parent/Legal Guardian) Type your name below in acknowledgement to the above form *
Your answer
Submit
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