Junior Camp 2 (July 12-16)

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2011 Fall Newsletter
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Go Daddy

Junior Camp (entering grds 4-6) July 9-13

The Missoula Alliance Church is providing a bus to transport campers to and from each camp for a reasonable fee. To make arrangements to be part of this opportunity, contact the camp at 406 882-4572.

Note: Camper's family insurance plan is the primary source of coverage for accidents.

Camper Name:
Gender:
Age:
Grade in the Fall:
Birth Date:
Mailing Address:
Home Phone:
Father's Cell Phone:
Mother's Cell Phone:
Parent/Guardian Email:
Camper's Email:
Emergency Contact Name:
Emergency Contact Relation:
Emergency Contact Home Phone:
Emergency Contact Cell Phone:
Insurance Carrier:
Primary Insured:
Policy Number:
Family Physician:
Family Physician Phone:
Date of last Tetnus shot:
Current Medications and dosage:
Allergies:
Dietary or Special Needs:
Activity Restrictions:
Camp Attendance:
Camp Bunk Buddy:
Swim Skill Level:
Please send me a camp newsletter:
Yes, my child's photo can be used in promotionals:
Sign me up to ride the Bus to camp!:
Parent/Guardian Name:

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