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JBC Camper Registration Form
Schulz_Rolf_
2022-04-13T09:21:46+09:00
Registration Form
General Information
Last Name
*
First Name
*
Birthday
*
Gender
*
Please choose
Male
Female
Which Camp
*
Please choose
Joy Bible Camp #1 (June 16 to 18 •¥15,000)
Joy Bible Camp #2 (June 19 to 21 •¥16,000)
Joy Bible Camp #3 (June 22 to 24 •¥17,000)
Postel Code
*
Address (Apt #/name, Street, City & Prefecture)
*
Parent/Guardian Information
Parent/Guardian Name
*
Full time Christian worker
*
Parent is a full time pastor or missionary
Yes
No
Cell Phone
*
Home Phone
Work Phone
Email
*
Emergency Contact Information
Name 1
*
Relationship
Cell Phone
*
Name 2
*
Relationship
Cell Phone
*
Health & Insurance Information
Is your child enrolled in Japanese National Health Insurance
*
Yes
No
Other insurance or explanation of coverage
Any Special Medical Conditions or Concerns
*
Yes
No
Specify medical conditions
Medication Taken Daily
*
Yes
No
List of medications and times to be taken
Any allergies
*
Yes
No
Explanation of allergies
Restricted Activity (Is this camper to be restricted from an activity?)
*
Yes
No
Explanation of restricted activity
Has had the tetanus immunization vaccine
*
Yes
No
Tetanus immunization date
Do you have any serious concerns about the above questions?
*
Yes, I want to talk to the kitchen staff.
Yes, I want to talk to a camp nurse.
No, not necessary.
Explanation of concerns
Travel Information
Arrival
*
Arrival by CAR to OBC between 3pm and 3:30pm
Arrival by TRAIN (PLEASE NOTE CAMPERS GO DIRECTLY TO OBC)
Departure
*
Departure by CAR picking up child from OBC between 2pm and 2:30pm
Departure by TRAIN (PLEASE NOTE THERE WILL BE NO STAFF WITH CAMPERS)
Release of Liability
Note to OBC
Release of Liability and Requested Permissions
Check here if you accept these terms.
Submit form
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