Super Summer 2010

Select session 1 or 3. 7th - 12th grade who attend Sunday School are invited. $50 + full participation in Bar-B-Que Auction or $225. Deadline for Registration is February 28.

If you have questions, or would like more information, please leave your name and contact information.

Gender:
Type of Registration:
Type of Registration

Student

T-shirt size

Are you attending Super Summer Global 2009? (yes no)
First Name:
Last Name:
Birthdate: (MM/DD/YYYY)
Email Address:
Emergency Contact Information
Name
Relationship:
Cell:
Home:
Work:
Medical Information
Recent serious injuries:

Recent surgeries:

Allergies to Medications:

Chronic Medical Conditions:

Other Pertinent Health Concerns:

Medications taken regularly:
Medications taken occasionally for headaches etc.:
Will you bring medications with you?

Session Choice

1:ETBU Marshall TX June 7-11
3:ETBU Marshall TX June 14-18
Team Leaders and Leadership Forum Participants
Please mark any areas that you would be willing to serve as a volunteer if needed.

Athletics
Marketing
Security
Medical
Participant Mailing Address
Street Address:
City:
State:
Zip Code:
Church Information:
Church Name:
Church City:
Church Contact Person:
Church Contact Phone:
Medical Insurance Information
Do you have medical insurance

Insurance Company:
Group Number:
Member Number:
Insurance Company Contact Information
Phone Number:
Street Address:
City:
State:
Zip:
Comments:
Security code:
*
Do not enter anything in this field:

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