Attendee Name:
Parents' Full Names:
Gender:
Birthdate:
Shirt Size:(Youth M,L Adult S,M,L,XL,XXL)
Home Phone:
E-Mail:
Mailing Address:
(Num. & Street)
City:
State:
Zip:
Group attending with:
(Name/city)
cabin mate request &
other special
notes/medical needs:
By submitting this form I agree that I am the parent or legal guardian of the above named camper and I certify that he/she has my permission to take a full, active part in the program at Camp Patmos. I further authorize Camp Patmos to administer necessary medical treatment in case of an accident or illness which occurs while a registered camper. I also realize that my camper's picture or testimony may be used in the promotion of the camp and my child may receive occassional email from Camp Patmos. call 419-746-2214
