Champion's Camp Volunteer/Buddy Registration Volunteer/Buddy Name* First Last Date of Birth* MM slash DD slash YYYY Volunteer's Age*Volunteer's Gender*T-Shirt Size*Youth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult XLAdult XXLAdult 3XLAddress* Street Address City State / Province / Region ZIP / Postal Code Phone*Email* Do you have a Camper you would like to work with? Yes No Camper's Name First Last Emergency ContactEmergency Contact #1 Name*Emergency Contact #1 Relationship*Emergency Contact #1 Phone #*Emergency Contact #2 Name*Emergency Contact #2 Relationship*Emergency Contact #2 Phone #*InsuranceInsurance CompanyName on Insurance PolicyInsurance Company Phone #Policy NumberDoes your Insurance Company require notification prior to emergency health care at a hospital?* Yes No If yes, Phone NumberMailing Address for Medical Claims (see back of insurance card)How would you rank your overall health? Poor Fair Average Good Great Excellent Are you on any prescription medication? Yes No Please list all prescription medications:Health Needs: (allergies, special diet, physical restrictions)Date of most Recent Tetanus Booster MM slash DD slash YYYY Special Diet (please explain)Is this the Volunteers first time to attend camp?* Yes No LodgingBase price for camp ($108) includes lodging in cabins in bunk beds. Lee Lodge hotel rooms are an additional $15 per person.Do you prefer a private accommodation with your camper in Lee Lodge hotel room? Yes No This may be needed for wheelchair purposes (although some cabins have accommodations). Cabins are housed same gender. Mother/son, father/daughter, or mixed gender buddy and campers may need to be housed in a hotel room.Walk with ChristTell us briefly about your salvation experience.Tell us briefly about your Christian growth since you were saved.Do you have any previous experience with individuals with special needs?* Yes No If so, please explain.What Volunteer position would you like to have?Authorization ConsentChurch Authorization* I agree to the privacy policy.I authorize the Church/Organization above as well as appropriate LBC (Louisiana Baptist Convention) Staff to have access to all of my registration information.Name of Volunteer/Buddy* First Last Your typed name and checked box above will serve as an electronic signature for authorization.Date of Signature* MM slash DD slash YYYY Deposit and PaymentWhat method will you pay for camp deposit today?* Pay by credit card with this form Mail a check to Tall Timbers Product name* Price: One volunteer deposit-$50 Credit Card*Card Details Cardholder Name Δ
