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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