Registration Form

 

General Information

Parent/Guardian Information

Full time Christian worker *
Parent is a full time pastor or missionary

Emergency Contact Information

Health & Insurance Information

Is your child enrolled in Japanese National Health Insurance *
Any Special Medical Conditions or Concerns *
Medication Taken Daily *
Any allergies *
Restricted Activity (Is this camper to be restricted from an activity?) *
Has had the tetanus immunization vaccine *
Do you have any serious concerns about the above questions? *

Travel Information

 

Arrival *
Departure *

Release of Liability