Winter Retreat 2023 Registration – College Church of Christ

Please upload copies of the front and back of primary and/or secondary insurance cards. NOTE: pdf format is recommended. If unable to upload, please make copies of the FRONT AND BACK of your card, label it with the camper's first and last name, and mail to College Church of Christ, 1284 E. Bullard Ave., Fresno CA 93710. UPLOADING INSTRUCTIONS: Take a photo or create a pdf of your insurance card and save it in your computer in a file folder of your choosing. Or, you can save it to your desktop. You may then drag and drop the file from your computer to the "Drop files here" box, or click on Select files to locate the file on your computer.

Winter Retreat 2023

Person Completing This Form

Camper Information

Who to Contact in Case of an Emergency

Primary Contact

Second Contact

Third Contact

Health Information

Medical Conditions

Allergies

Medications

What medication does the camper/staff member take for:

Medical Insurance

Fee Payment

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