FLAG CAMP Registration - July 10-14 : C F Richards Christian School Staunton VA

Date

Camper Name

Birthdate

Gender

Child's Tshirt Size

Address

Parent/Guardian Name

Parent/Guardian Email

Phone

Emergency Contact

Emergency Contact Phone

Emergency Contact Relationship

Medical Information

Allergies

Medications

Physician's Name

Physician's Phone

Insurance Name and Policy Number

Guardian Consent

My child can participate in FLAG Camp Pictures of my child may be used for future advertising purposes. In the event of accident or urgent illness, I give permission to the FLAG CAMP staff to authorize nedessary emergency treatment for my child. My child has my consent to participate in FLAG CAMP field trips.

Signed electronically (typed)

Relationship

Date

Click here to make FLAG Camp payment ($90 +$4 processing fee) or mail check ($90) to CF RIchards Christian School, 414 Sterling Street, Staunton, VA 24401