Camp E.D.G.E.

One child per form please! The medical information is optional but very helpful in case of an emergency.

Child's Information
Child's Name::*
Birthdate:*
Address (line 1)::*
Address (line 2)::
City::*
Zip/Postal Code::*
Phone::*
Last grade completed:*
Name of home church:
Parent's Information
Parent Name::*
Parent Contact Phone (other than listed above)::
Parent E-mail:
2nd Parent Name::
2nd Parent Contact Phone (other than listed above)::
2nd Parent E-mail::
Emergency Medical Information
Emergency Contact::*
Allergies or Other Medical Condition:: (ex. food allergies, ADHD, etc.)
Doctor Name:
Doctor Phone::
Insurance Company Name::
Policy Holder::
Sponser/Group Number::
Member Number::
I give permission for photographs of my child taking part in the Sewickley United Methodist Church Camp EDGE VBS 2009 to be used on the SUMC website and/or other church publicity materials. No child will be individually identified.
Optional Purchases and Credits
Volunteer Credits:: (Check box and fill in name of volunteer to receive credit. The name will be listed under the name we call you, i.e. Susie or Angie, and your last name.)	Credit For Credit For