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Power Camp 2010
Camper #1 Information
First Name*
Last Name*
Age*
Address*
City*
State*
Zip*
Phone*
Parent's Email*
Gender* Male
Female
Grade Completed*
Sport*
T Shirt Size*
Camper #2 Information
First Name
Last Name
Age
Gender Male
Female
Grade Completed
Sport
T Shirt Size
Camper #3 Information
First Name
Last Name
Age
Gender Male
Female
Grade Completed
Sport
T shirt Size
Camper #4 Information
First Name
Last Name
Age
Gender Male
Female
Grade Completed
Sport
T Shirt Size


Consent / Medical Waiver
In the event of an emergency in which my son/daughter requires medical attention, I authorize the agents of this organization to seek and secure any needed medical attention or treatment including hospitalization, if in the agent's opinion such need arises. I specifically consent to such medical treatment and will be responsible for any medical charges in connection with his/her participation in the FCA organized event. I specificially agree to waive and release the Mid Missouri Fellowship of Christian Athletes, its employees, officers, or agents from liability for any claim for damages which I or my son/daughter have or any have against any facility and its owner operator, program coordinator, coach or any other volunteer who participates in the FCA organized event.
Consent?* Yes
Consenting Parent/Guardian Full Name*

Emergency Contact
Emergency Contact Name*
Emergency Contact Phone Number*
Security Image*
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* indicates a required field
  


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