ABA Sports Camp July 17-20 , 2017 Pre-registration Form
In order to register, please complete this form.
Student's Name
Your answer
Street Address
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Email Address
Your answer
Student's Age
Your answer
Student's Date of Birth
MM
/
DD
/
YYYY
Student's Grade Completed
Parent/Guardian(s) Name(s)
Your answer
Day Time Phone
Your answer
I give consent for the applicant to attend the Appomattox Baptist Association Sports Day Camp; I will not hold the Appomattox Baptist Association or its partnering churches liable in case of accident or illness. I further state that I am the legal parent or guardian of the applicant. I also give my consent for necessary medical treatment in case of emergency.
Does your child have any medical conditions or allergies that we should be aware of?
Your answer
Hospital Insurance Information
Insurance Company Phone Number
Your answer
Insurance Company Name
Your answer
Insurance Company Policy Number
Your answer
If you attend a church, which one?
Your answer
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