Mountain View Christian Camp

Sunset Church of Christ

1308 W. Blodgett

Carlsbad, NM 88220

505-887-1278

sunsetchurchofchrist@yahoo.com

http://www.sunsetchurch.org

Fill out this form COMPLETELY and please print it and send it in with your deposit check. This form will not automatically reserve your space... your space will only be reserved when it is received in snail mail. Thanks!

Camper's name:
Age:
Sex:	Male Female
School grade in 2009-10
Address:
City:
State:
Zip:
Home Phone (incl. area code):
E-mail address:
Emergency contact number if parent can't be reached:
Parent/guardian name:
Parent/guardian cell phone number:
Describe any important health information, such as allergies to drugs, food, plants, or insect bites; medication currently taking, etc:
Date of last tetanus shot:
T-shirt size:
Select the week you wish to attend camp:
Name of home congregation:
Address of home congregation:
Is this camper baptized?	Yes No
I give my permission for my child to be baptized at camp.	Yes No
INSURANCE INFORMATION
I understand that in the event of injury or illness, the family medical insurance will be primary as follows:
Insurance company:
Insurance company phone:
Insurance policy number:
Responsible party name:
Medical release: I give permission for my chlid to receive emergency medical treatment from a qualified physician. I release Sunset Church of Christ and all Camp personnel from further liability. It is further agreed that Mountain View Christian Camp will not be responsible for my child's property. Parent or guardian's digital signature: