MEDICAL FORM

Sunshine Church of Christ Youth Rally

Please fill out one copy of this page for each member of your group.

Date of youth rally_______________________________

Name ______________________________________________________________

Age______ Sex ______

Name of group/church ___________________________________________________

Name of group's counselor/chaperone _________________________________________

Contact in case of emergency:

Name______________________________

Relationship ___________________________

Daytime Phone________________________

Evening Phone_________________________

Medical Insurance _____________________________________________________________

Insurance Identification Number __________________________________________________

Employer through which insurance is received ________________________________________

Known allergies/medical conditions ________________________________________________

Describe reaction and indicate medication used _______________________________________

Is there any type of activity restriction? ____

If yes, please explain _____________________________________________________________

_____________________________________________________________

Any other information?


Assigned to cabin #___________

INDIVIDUAL REGISTRATION FORM

Sunshine Church of Christ Youth Rally

Please fill out one copy of this page for each member of your group.

Date of youth rally___________________________________

Your name _________________________________________________________________

Age______ Sex ______

Group/church you are with_______________________________________________

Name of group's counselor/chaperone ____________________________________________

I have allergies or other special medical needs. (Please specify on medical form)

Other pertinent information:




Assigned to cabin #_________

YOUTH RALLY GROUP REGISTRATION FORM

Sunshine Church of Christ Youth Rally

Please fill out one copy of this page for your entire group.
Cabin # will be assigned at registration.
Use back of sheet if you have more than 16 people in your group.

Date of youth rally_________________________

Group/Church Name _____________________________

Address: ______________________________________

City:____________________State:____ Zip:__________


Contact in case of emergency:

Name____________________________________________

Daytime Phone________________________

Evening Phone________________________


Name M/F Cabin #

Group counselor/chaperone
__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

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