30th Annual Crossfire Basketball Camp

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SELECT YOUR CAMP WEEK

Total Cost $

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First Name

First

Last Name

Last

Address *

Address

Street Address

Address two

City

State/Province

Zip/Postal

Home Phone *

Cell Phone

Your Age

Date of Birth *

Choose *

Grade Completed

School Name

Parent/Legal Guardian 1 *

Parent/Legal Guardian Email Address

Parent/Legal Guardian 2

2nd Parent/Legal Guardian Email Address

Have you attended a CROSSFIRE CAMP before?

Yes

If yes, when?

INSURANCE INFORMATION: For all campers

Insurance Carrier

Emergency Contact *

Email *

Home Phone *

Work Phone

Cell Phone

Alternate Emergency Contact

Home Phone

Work Phone

Cell Phone

Allergies of which staff needs to be aware! *

If none please state 'None' in form field

Are you choosing Overnight Camping?

Yes

FOR OVERNIGHT CAMPERS ONLY

Roommate Preference: (FIRST COME, FIRST SERVE BASIS)

Roommate 1

Roommate 2

OK to give acetaminophen (Tylenol)

Yes

OK to give ibuprofen (Advil or Motrin)

Yes

OK to give TUMS

Yes

Prescription Medications

Medical conditions which requires prescription medication if applicable please provide list of meds/amount/time of administration.
PLEASE NOTE: All meds will be administered by staff/No meds are to be kept in dorm rooms.

PARENT: PLEASE READ AND SIGN

It is understood that Crossfire Ministries Int'l, Inc. reserves the right to require additional information and documentation related to this application to be completed and filed with Crossfire Ministries Int'l, Inc before camp participation is allowed.

As a parent of *

Who is Age *

..., I represent to Crossfire Ministries Int'l, Inc that said child is free from any physical or mental impairment or condition that would prevent him/her from participating in camp activities. I, as parent, further represent to Crossfire Ministries Int'l, Inc that said child has no medical condition that requires medication or medical attention OR child does have a medical condition that requires medication or medical attention, as described in the following space:

Medical Condition

I further assume all responsibility for any possible health problems or accidents which might occur while my child is in camp and will not hold responsible the following parties/organization: Asheville School, Asheville Christian Academy, First Baptist Church of Hendersonville, Mars Hill University, Mars Hill Elementary, North Buncombe Middle School, North Buncombe High School.

Parent/Guardian Signature *

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Crossfire Ministry

Sharing Jesus Since 1993

30th Annual Crossfire Basketball Camp

User Registration Information

INSURANCE INFORMATION: For all campers

FOR OVERNIGHT CAMPERS ONLY

PARENT: PLEASE READ AND SIGN