"*" indicates required fields Name* First Last Gender* Male Female Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Age*Local Church Location Pastor's Name In case of medical emergency, I understand an effort will be made to contact the parent or guardian of the camper. In the event that I cannot be reached, I give permission for my child to be treated and transported to the hospital and any necessary medical procedures to be secured. I agree.I understand in the event of an emergency (accident or sickness) for which the camp insurance does not provide, the expense is my own responsibility and the Camp/Retreat will not be held liable for any expense in such case. I agree.Signature*Guardian's Phone
