2021 TCBA Leader Application
Training dates: May 11, 2021 6:30 North Nixa Baptist Church 1730 N. State Hwy CC
                          (background check forms will be filled out and submitted)
                           June 6, 2021 5:30 pm Baptist Hill Assembly 9519 State Hwy V, Mt Vernon
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CAMPER LEADER APPLICATION
Your Email Address *
First Name *
Last Name *
Assignments *
What is your preference?
Обов’язково
Gender *
Church attending Camp with *
T shirt size *
Date of Birth *
ДД
.
ММ
.
РРРР
Home phone *
Cell phone *
Work Phone
Medical Conditions *
Are you under a doctor's care at present?
If so for what?
Doctor's Name
City, State
Do you have health insurance?
Скасувати вибір
Company
Will you be taking medication at the time of camp?
List all medications
Скасувати вибір
If yes, please list all medications
List all medications
Allergies to food or medication? *
Please list all known allergies
Do you have any physical disabilities that would keep you from active sports participation? *
If yes, please list them:
Emergency Contact *
Please give name, relationship, and phone number of individual(s) to contact in the event of an emergency, if a parent or guardian cannot be reached.
DIRECTORS, BIBLE TEACHERS, CAMP PASTOR OR WORSHIP LEADERS ONLY:  Children coming with you (not as a camper)
List Name, Age & Female or Male
PERMISSION-DO YOU GIVE CONSENT? *
By submitting this form you will be giving your permission for TCBA Camp Staff to seek emergency medical treatment if necessary. Submission of this form further gives TCBA Camp nurse permission to administer first aid to you as necessary during the week of June 7-10, 2021.  *Junior Cabin Leader PARENTS/GUARDIANS:  Your signature also gives permission for TCBA Camp Staff to seek emergency medical treatment if needed for your minor child while at camp.
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Цю форму створено в домені Tri County Southern Baptist Association. Повідомити про порушення
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