Florida Alabama Camp Application - 2010 Senior Camp
First Name Mailing Address
Last Name City
Date of Birth      State   Zip 
Gender MaleFemale Home Number
Returning Camper Grade Completed Cell/Work Number
Parent Name Will your parent(s) be working at one of our camps?  
Parent Email Requested Bunkmate (only one)
Camper Email First Name
T-Shirt Size YouthAdult   Last Name
Would you like to purchase a camp DVD for $15 
Would you like to purchase a camp directory for $2 
Name(s) of siblings attending camp (if any) Health Insurance Company
Policy,Contract or FamilyId

Group Number

If admitted this camp, I hearby agree to abide by the rules. I have read and
understand the purpose of the campas outlined in the camp brochure.		 Emergency Contact Name
I Agree   Emergency Contact Phone

Florida Alabama Camp Activities
Select up to 6 Activities you would like to participate in
(Use Control Key + Click to select multiple)

Florida Alabama Camp Health Information
Date of last tetanus shot/booster (Should be within the last 5 years)
Please list any allergies this camper has. Include:
1.) The general allergy (i.e. food, medicine, insect bite or sting, other),
2) the specific allergy (e.g. the type of food, such as peanuts),
3) the type of reaction that occurs, and
4) the treatment needed.
Please list any medications your child takes on a regular basis and the reason for the medication. Bring your child's medications in their ORIGINAL containers. Do not bring pill cases or unlabeled medications.
Please list any physical restrictions this camper may have (e.g. asthma, diabetes, blood pressure, depression, etc.). Also, please share any special health related information we need to know about this camper.