Mail OR BRING TO:                       CAMP CHALLENGE

                                                                                   254-702-7296                          Camp Director, Fred Ybanez

                                                                                                                                                 4 Wyatt Earp Dr

                                                                                                                                       Morgan's Point Resort, Texas  76513

   Date TBAN, 2020                                                      T-Shirt Size:  ___________________________  Registration Fee: $150 *****************************************************************************************************************************************************************************

            Child's Name:_______________________________________________________________________                                       Date of Birth:_______________________________

Parent/Guardian's Name:________________________________________________________________________________________________________

Home Address:________________________________________________________________________________________________________________

Home Phone:__________________________________Cell:_________________________E-Mail:______________________________________________

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PICK-UP INFORMATION: (This information is for the camp director, in the event your child is picked-up from camp or any field

trips by anyone other than the child's parent/guardian.

Name/Phone/Relation:_____________________________________________________________________________________________________________

Name/Phone/Relation:_____________________________________________________________________________________________________________

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EMERGENCY/MEDICAL INFORMATION: (Child must be able to participate in all camp activities, any medical problems preventing your child from participating will prevent your child from registering for Camp Challenge).

Emergency Contact (othet than parent):_________________________________________________________________________________________________

Emergency Contact Phone:______________________________Allergies:_____________________________________________________________________

Preferred Hospital's Name:__________________________________Doctors Name:_____________________________________________________________

Insurance Carrier:_________________________________________Policy Number:_____________________________________________________________

Known Medical Condition(s):__________________________________________________________________________________________________________

Medications:_______________________________________________________________________________________________________________________

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YOU CAN PURCHASE A CAMP HAT THROUGH

CAMP CHALLENGE

CAMP HAT: $15.00 EACH

ENCLOSED PAYMENT FOR CAMP HAT:  TOTAL:_____________________

PAYMENT CAN BE ADDED WITH THE REGISTRATION AMOUNT


THIS IS A AN OPPORTUNITY TO GIVE A CHILD THE CHANCE THEY MAY NEVER GET;

SPONSOR A CHILD: $150 DONATION WILL SEND A CHILD TO CAMP FOR 1 - WEEK.