Abbott Mountain View Bible Camp 2017
Abbott Mountain View Bible Camp 2017

Please complete this registration form and click continue to make your payment online.

July 9, 2017– July 13, 2017

Camper’s Name  * 
Address  * 
City  * 
State  * 
Zip Code  * 
Camper’s Birthday  * 
Camper’s Gender  * 
Church Affiliation (if any)
Medical Insurance Company  * 
Policy Number and Member’s Name  * 
Primary Physician and Phone Number  * 
Emergency Contact Name  * 
Emergency Contact Phone Number  * 
Your Email Address  * 
If your child uses any prescription or over the counter medications, please have your physician complete the attached Physician’s Medication Order Form.
By clicking continue, I/we give permission for our son/daughter to participate in the Abbott Memorial Church summer camp program. In the event I cannot be reached for an emergency, I hereby give permission to a licensed physician to hospitalize, secure appropriate treatment for and to order injection, anesthesia, or surgery for my son/daughter. I also agree to assume obligation for any necessary expenses and hold harmless Abbott Memorial Presbyterian Church, its staff and sponsors, from responsibility and liability for any injury or illness my son/daughter may sustain during this event.
Total $
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