St. Mary & St. Mina Coptic Orthodox Church Summer Camp (Jun 4th-Aug 6th 2019)
Terms
By Registering through this form, I agree to abide by any/all policies and rules established for this camp activities. Should I not be able to maintain the guidelines and expectations of the adults and my peers, I understand that there will be consequnces for my actions, including being removed from the activities and sent home at my/my parents' expense. Basic rules/expectations include but not limited to: Respect for all adult leaders, peers, and all property; NO illegal drugs, smoking, alcohol, firearms, explosives, or other illegal substances; Appropriate attireis to be worn at all times; Any other guidelines may be set forth accordingly by adult chaperones present for the event(s).
First Name *
Your answer
Last Name *
Your answer
Date of Birth *
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DD
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Address *
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Home Phone Number *
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Father's Full Name *
Your answer
Father's Phone Number *
Your answer
Mother's Full Name *
Your answer
Mother's Phone Number *
Your answer
Emergency contact if unable to reach parent/guardian
Name *
Your answer
Relationship
Your answer
Phone Number *
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Medical Insurance Information
A Copy of the insurance card (both sides) must be attached to this form
Medical Insurance Carrier *
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Insurance Company Phone Number *
Your answer
Policy Number *
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Current Medication and dosage (Physician's prescription or parent note must be attached to this form and to the medications) *
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Other special considerations or conditions to be aware of (ie: allergies, medical conditions, etc...)
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