2010 Missions, Volunteers, and Comeback Kids Camp Application
page 2 of 8
 
In case of emergency please notify:
Your (applicant's) initials
Emergency contact Name
Relationship
Address
City, State, Zip
Phone(home)
Phone(work)
How would you describe your present health? Excellent Good Average Poor
 
Please summarize any physical disability:
Summarize Current illness or condition:
Current prescription medicines:
Do you have health insurance? Yes No
Insurance Company Name


[Send page 2] and you will receive confirmation here.  

 

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