2018 ALA Junior Camp Application Form
All fields must be filled. If the question does not pertain to you place 0 in that field.
Camper's First Name *
Your answer
Camper's Last Name *
Your answer
Camper's Middle Inital *
Your answer
Camper's Mailing Address *
Your answer
Camper's Mailing City *
Your answer
Camper's Mailing State *
Your answer
Camper's Mailing Zip *
Your answer
Camper's Date of Birth *
MM
/
DD
/
YYYY
Camper's Home Phone Number *
Enter your 10 digit phone number. No spaces/slashes/dashes. eg 0123456789
Your answer
Camper's Cell Phone Number *
Enter your 10 digit phone number. No spaces/slashes/dashes. eg 0123456789
Your answer
Camper's Height *
Your answer
Camper's Weight *
Your answer
Camper's Hair Color *
Your answer
Camper's Eye Color *
Your answer
Camper's First Contact *
Please use full name. e.g. Jane Doe
Your answer
1st Contact Cell Phone Number *
Enter your 10 digit phone number. No spaces/slashes/dashes. eg 0123456789
Your answer
1st Contact Home Phone Number *
Enter your 10 digit phone number. No spaces/slashes/dashes. eg 0123456789
Your answer
1st Contact Work Phone Number *
Enter your 10 digit phone number. No spaces/slashes/dashes. eg 0123456789
Your answer
1st Contact Company Name *
Your answer
1st Contact Days/Hours Worked *
e.g. M-F 8:00 - 4:00
Your answer
1st Contact Relationship *
e.g. Mother, Father, Aunt
Your answer
2nd Contact Name *
Please enter full name. e.g. Bill Smith
Your answer
2nd Contact Cell Phone Number *
Enter your 10 digit phone number. No spaces/slashes/dashes. eg 0123456789
Your answer
2nd Contact Home Phone Number *
Enter your 10 digit phone number. No spaces/slashes/dashes. eg 0123456789
Your answer
2nd Contact Work Phone Number *
Enter your 10 digit phone number. No spaces/slashes/dashes. eg 0123456789
Your answer
2nd Contact Company Name *
Your answer
2nd Contact Days/Hours Worked *
e.g. M-F 7:00 - 5:00
Your answer
2nd Contact Relationship *
e.g. Mother, Father, Uncle
Your answer
Contacts eMail Address *
Your answer
Adult t-shirt *
Required
Physician's Name *
Your answer
Physician's Phone Number *
Enter your 10 digit phone number. No spaces/slashes/dashes. eg 0123456789
Your answer
Date Of Last Examination by Physician *
Your answer
General Health Condition *
Required
Recent Illness or Injury (Describe) *
Your answer
List All Medications (including over-the -counter and prescription(s) and why are they taking the medication. *
Your answer
Medications That the Junior Camper Should Not Be Given *
Your answer
Allergies *
Required
Other Allergies. Please List *
Your answer
Does the camper have any food allergies? *
List food allergies. *
Your answer
Subject To *
Required
Other Subject To *
Your answer
Has History Of Or Under Care For *
Required
Explain Other Has History Of Or Under Care For *
Your answer
Date Of Last Tetanus Shot *
Your answer
Has Appendix? *
Has Tonsils? *
Required
Wears Glasses or Contact Lenses? *
Does Girl Wear *
Required
The girl does or does not stay over-night, away from home without becoming homesick. *
The girl has or has not stayed over-night, away from home for a continuous week prior to Junior Camp *
Does this girl get her feelings hurt easily?
Any personal information that would help the Junior Camp Staff better understand and relate to your girl to make her experience pleasant? *
Your answer
May staff give asprin or Tylenol if deemed necessary? *
Health Insurance Company *
Your answer
Policy Number *
Your answer
District Number *
Your answer
Name and full address of your local newspaper. *
Your answer
Unit Town *
Your answer
Unit Number *
Your answer
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