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STUDENT LIFE CAMP REGISTRATION

Submission of this form and $150 will reserve your spot for camp.

Student Name *
Student Name
Address *
Address
Phone *
Phone
Date of Birth *
Date of Birth
Gender *
My child has my permission to attend Student Life Camp 2018 at Orange Beach, AL on June 18-22, 2018. I have read and agree with all of the information on the brochure. My student also has permission to participate in any recreation a his/her own discretion. I realize that there is risk associated with any activity and I assume full responsibility for the welfare of my child. I will not hold First Baptist Church, nor any of its sponsors, leaders, staff, agents or representatives responsible in cases of injury or illness. This statement authorizes the church sponsors to seek medical and/or surgical treatment in the event of an emergency. *
Medical Information
Phone *
Phone
Physician Phone *
Physician Phone