Please send your $25.00 deposit and completed Medical Form (if under 18) to:

The ARC; 2372 30th Avenue; Osceola, WI 54020

A $20.00 registration charge will be added if pre-registration is not received 10 days prior to start of camp.

Please print this form and mail it to The ARC 2372 30th Ave, Osceola, WI  54020  or call 1-800-294-2877.

ENTER NAME (S) BELOW:

AGE

MALE

FEMALE

ADDRESS

CITY/STATE/ZIP

PHONE

EMAIL

CHURCH

Please use box below for roommate requests and to order your

PARENT OR GUARDIAN

EMERGENCY PHONE

FAMILY INS CO

PLAN/POLICY

LIST HEALTH PROBLEMS/LIMITATIONS

MEDICATIONS

ALLERGIES

IMMUNIZATION - DATE OF LAST TETANUS SHOT

*PARENTS SIGNATURE NEEDED

_______________________________________________________________________

*PARENT’S SIGNATURE AUTHORIZES EMERGENCY TREATMENT IN THE EVENT THE PARENT IS NOT IMMEDIATELY AVAILABLE. THIS PERMISSION ALSO AUTHORIZES CAMP STAFF TO INSPECT CAMPER’S BELONGINGS TO SEE THAT THEY HAVE NOT BROUGHT PROHIBITED OR ILLEGAL ITEMS.