Heritage Sports Camp June 10-13, 2019
In order to register, please complete this form for every child.
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
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DD
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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 Heritage Baptist Church Sports Camp; I will not hold the Heritage Baptist Church or its Volunteers liable in case of accident or illness. I further state that I am the legal parent or guardian of the applicant. I give permission for my child to be photographed during the week 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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