SonQuest Rainforest Camp
June  21-25, 2010

Camper Information
This is for our use only. You will not be added to any other lists.

By submitting this form, I understand that I assume all responsibility in case of an accident.  In the event of an emergency involving my child (or children), I request that I be contacted at the number(s) below.   If I am unavailable, you may contact one of the alternate people listed below.  In the event that none of the emergency contact people are available, I give my permission to contact the below named physician (or their representative) to secure proper medical treatment, including, if necessary, emergency treatment and hospitalization. I accept responsibility for all costs incurred.

Parent(s)/Guardian(s) Name:
Home Phone Number:
Work Phone Number:
Mailing Address:
City:
State:
Zip:
Email Address:
2nd Emergency Contact Name:
Emergency Phone Number:
Physician
Insurance Company
Plan Numbers:
First Child's Name:
Birth Date:
T-Shirt Size:

School Grade:
(Completed as of 6/10)


Second Child's Name:
Birth Date:
T-Shirt Size:

School Grade:
(Completed as of 6/10)


Third Child's Name:
Birth Date:
T-Shirt Size:

School Grade:
(Completed as of 6/10)


Fourth Child's Name:
Birth Date:
T-Shirt Size:

School Grade:
(Completed as of 6/10)


Fifth Child's Name:
Birth Date:
T-Shirt Size:

School Grade:
(Completed as of 6/10)

Please list any medical conditions or special concerns with respect to your child or children
(i.e. known allergies, ailments) additional information.

I can't volunteer but would like to bring a snack or drink, please call me!

Donations are greatly appreciated.  Suggested Donation is $35 per child or $65 per family
$10 per Student Volunteer to cover t-shirt cost (Student Volunteers must be graduating 8th graders and up)

Please make checks payable to: BSC - Vacation Bible School
Thank You!