Smoky Mountain Christian Camp
Summer Registration
Camper Basic Information
Name
Address
Zip Code
City State
Camper is:
Camper is entering grade:
Camp Week Desired
Camper Medical Information
Check any that apply to the camper
Allergies to Drugs
Heart Condition Chronic Ear Infections
Perscription Medication
Diabetes Activity Restrictions
Convulsions
Allergies
Other
If you checked any of the above please explain. We need to know what the problem is, what medications (if any), and any special instructions.    When the camper comes to camp, please have all medications labeled and in a zip loc bag. On the outside of the bag  label  it  with  the  campers  name,  date  attending c amp,  and  any  special instructions and times for medication.
Date of last tetanus:
Insurance Company:
I.D. Number:
Policy/Group Number:
Parent/Guardian Name
Phone Number
Give another name and phone number in case the parent cannot be reached at the number given above. This will only be used in case of emergency. The parent/guardian will always be contacted first if possible.
Name of other contact Phone of other contact
Click on submit to send this registration immediately. This form can also be printed out and sent through regular mail. Send it to: Smoky Mountain Christian Camp, P.O. Box 116, Coker Creek, Tn. 37314. (Please note: Click on the following address. This must either be sent to the camp or brought with the camper:
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