Sports Camp Registration By | July 26, 2016 Email Address* Camper Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Cell Phone Number*Gender*MaleFemaleHow many years have you attended a Maranatha summer camp?*0 - First Time12345678What is Camper's age during camp?*What grade will Camper be in this coming fall?*Year of expected high school graduation*Name of School*Parents' Phone Number*Parents' Email Address*Please enter an address to receive camp updates and receipts Request a roommate for campWhich camp will you be attending?*Girls Basketball—June 18-22Boys Basketball—June 25-30Girls Soccer—July 23-27Boys Soccer–July 23-27Girls Volleyball—July 23-28Boys Volleyball—July 23-28HeightShirt Size*(Adult sizes only)XSMSMMLXLHS TeamVarsityJr. VarsityJunior HighCoach's NameAll campers must have insurance documentation and tetanus and MMR vaccination records to participate in camp. All prescription medications must be given to the camp Health Supervisor in their original containers with instructions for dosage and times for administration upon check-in. We recommend that your child have a physical sometime within 12 months before attending camp.Medical Release*You must complete a medical release to be registered for camp. "I, (type parent's name)...""...declare that I am the..."*FatherMotherGuardian"...of (type camper's name)..."I hereby authorize the Camp Health Supervisor to dispense over-the-counter medications as per standard medical practice. In case of medical emergency when I cannot be reached by telephone, I hereby authorize the staff of the Maranatha Camps to secure appropriate medical treatment such as X-ray examination, anesthetic, injection, medical or surgical diagnosis or treatment, and hospital care necessitated by injury or illness, while the above-named child is attending a Maranatha camp. I agree to the release of any records necessary for referral, treatment, billing, or insurance. Services are to be rendered to the camper by legally qualified personnel. I hereby affirm that my child has no physical conditions that will limit participation in the full range of activities being planned, except as listed below. I hereby waive and release Maranatha from any and all liability.Parent/Guardian indicates agreement with above statement electronically by typing their full name here*Health Information: PhysicalYes, my child has had a physical in the last 12 monthsNo, my child has not had a physical in the last 12 months; I understand that a physical is recommended and take full responsibility for my child's health conditionIf yes, please enter where your child's physical is on file*Name of Camper's Physician*Physician's Phone Number*All campers who do not have insurance MUST complete the insurance waiver formInsured's Name*Insurance Company*Policy Number*Insurance Phone Number*All campers who have not been immunized must complete the Immunization Waiver FormDate of Last Tetanus Shot*Date of MMR injections*Allergies (list all)* Current Medications (list all)* Pre-existing Injuries*Please briefly describe pre-existing injuries or other special medical conditions, or activities to be restricted. (Type N/A if not applicable)Payment MethodOnline Payment (payment link in next field below)Check/Money OrderMake checks out to Maranatha Baptist University and send payment to: ATTN: Jennifer Dunlop Maranatha Baptist University 745 West Main Street Watertown, WI 53094VerificationBy submitting this registration form I agree to allow Maranatha the right to freely use, publish, and reproduce, for all purposed, all captured audio, video, and images of the camper. (Type name below) First Middle Last This iframe contains the logic required to handle Ajax powered Gravity Forms.