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Coach Registration 2024

* Last Name:

* First name:

* Employer:

Cell phone:

* I have permission from my department to work at camp:

* Men's shirt size:

Employer Address:

* Parent, Guardian or Adult E-mail:

Assignment Preference #1:

Assignment Preference #2:

Assignment Preference #3:

Emergency Contact Information #1

Name:

Relationship:

Home Phone:

Cell Phone:

Emergency Contact #2

Name:

Relationship:

Home Phone:

Cell Phone:

Medical Information

Medical Insurance Company:

Policy Number:

Please list any allergies (medications/food), recent illness, surgeries, medical restrictions, disabilities, or extenuating circumstances that camp staff should be aware of::

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