Vision Camp Application

youthfortruth.org

Have you ever been to Vision Camp?
Full name
Address
Telephone
Email address
Age during Vision
Date of birth
Sex
Mens T-Shirt size
Who has legal custody?
Phone number for other parent (not living with you)
Do you attend church?
Where do you attend church?
Rate your relationship with Jesus Christ. 1 being poor and 10 being great
Suggest up to 3 names for cabin/tent mates (No Guarantees):
Emergency Contact
Name:
Phone:
Relationship to you:
Medical History
Do you have or have you had:	Blood sugar problems Seizures Fainting spells Eating disorders Respiratory problems Psychiatric care Stomach problems Severe allergic reactions Food allergies Any other medical restrictions Are you using prescription medication
If you answered yes to any of the above please explain:
Is Tetanus current?
Please list Medical Insurance Company and Number: