Camper Personal InformationFull Name of Camper:*(Required) Preferred Name Date of Birth*(Required) Month Day Year Gender(Required)FemaleMaleGrade in 2024 School Name School District Camper T-Shirt SizeYouth LAdult SAdult MAdult LAdult XLParent Contact InformationParent/Guardian Name*(Required) Relationship to Camper*(Required) Address City/State/Zip *(Required)Home Phone #Office Phone #Moblie Phone #Email Non-Parent Emergency ContactName(Required) Relation to Camper*(Required) Address City/State/ZipHome Phone #Alternate Phone #Email Insurance InformationParents and guardians are responsible for medical expenses incurred for illness or injury at Choir Camp. Insurance Co/Medicaid: Name of Insurance Company: PhonePolicyholder's Name: Policyholder's Date of Birth: Month Day Year Insurance ID Number: Insurance Group Number: Medicaid ID Number: If no insurance, responsible party: Allergies & IllnessPlease list any allergy:Allergy Response:Date of Last Reaction: Month Day Year Please list any allergy:Allergy Response:Date of Last Reaction: Month Day Year List over-the-counter medications the camper cannot receive for minor symptoms.Operations/Serious Injuries & Dates:Chronic or Recurring Illnesses:Diagnosed with:ADDADHDHas a psychiatric diagnosis such as Depression, OCD, and Panic/Anxiety Disorder. Yes Has seen or is seeing a professional to address mental/emotional needs. No Yes This camper has a learning disability/challenge. No Yes Has camper ever required any psychiatric counseling or hospitalization? No Yes MedicationsPlease list medications that will be given to camp nurse on check-in, including drug, dosage and condition requiring the medication. Prescribed medication and inhalers MUST be in original container with pharmacy label that includes camperโs name, valid date, instructions and Drโs name. Sample medications MUST have signed physicianโs letter. Over-the-counter medications MUST be in original packaging with valid expiration date.Drug/Dosage/ConditionDrug/Dosage/ConditionDrug/Dosage/ConditionCamper InformationPrevious Music Camp experience? No Yes Other Previous Camp experience? No Yes Where/When?Does camper have siblings? No Yes # older: # younger: Name of church:*(Required) City*(Required) Camperโs musical ability will be assessed on arrival at camp. Please describe camperโs past musical experiences or lessons, choir or band:No previous musical or choral experience is required for attendance.Is the camper part of a choir, band or orchestra?AllChoirBandOrchestraNoneWhat are your camperโs interests, hobbies, and activities?Describe your camperโs personality:Please include limitations, characteristics, or behavioral issues which could help the staff in working (sunburn sensitivity, sleepwalking, bedwetting, etc.)Are both parents living? No Yes Camper lives with:Both parentsFatherFather/Step-MotherGrandparentsMotherMother/Step-FatherParent GuardianPlease rate your camper in the following areas: 4 = Excellent 3 = Good 2 = Needs Improvement 1 = No experience Ability to live cooperatively in a community setting for a period of six days:1234Ability to independently take care of their own personal needs (i.e. showering, personal hygiene, dressing, etc.)1234Ability to stay away from home for an extended period of time:1234Roomate PreferenceRoommate requests will be honored as much as possible, but no requests are guaranteed. Rooms are double-occupancy, two room suites with showers.1 (First and Last Name) 2 (First and Last Name)