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Snow Blast 2012 Registration
Please fill out the following information for your camper. Starred (*) fields are required.
Camper information
*Camper name:
*Gender: Male Female
*Please select Middle School (Grades 6-8) or Sr High (Grades 9-12) Camp:
What church are you coming with?
Medical information
Please list any medical allergies
Please list any food allergies (Please note Riverview will not be responsible for ensuring food is allergen free)
Is the camper taking any medications? Yes No
If yes, please list all medications.
Is there any other medical information we should know of?
Parent/Guardian information
*Parent/Guardian Name:
*Address:
*City:
*State:
*Zip:
Email:
Home Phone:
Cell Phone:
Work Phone:
Emergency Contact information
The emergency contact needs to be available to pick up the camper at any time, and at their own cost
*Name:
Relation to Camper:
Home Phone:
Cell Phone:
Work Phone:
Release and Arbitration Agreement
I have read and agree to the Release of Liability, and agree to it.