MCC Camp Salah

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Camper's Information

Camper's Name *

First

Last

Camper's Age *

Is the camper presently being treated for an injury, sickness, condition or taking any form of medication for any reason? *

Is the camper allergic to any type of food or medication? *

Parent's Information

Parent's Name *

First

Last

Email Address *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Emergency Contact Information

Name *

First

Last

Phone *

Terms & Conditions

Checkboxes *

I agree to the following terms: *

I understand that the parent or emergency contact will be notified in the case of a medical emergency involving the camper. In the event that the parent or emergency contact cannot be reached, I authorize the calling of a doctor(ER) and the providing of necessary medical services in the event the camper is injured or becomes ill.

I understand that MCC will not be responsible for the medical expenses incurred, but that such expenses will be the responsibility of the camper or the parent/guardian.

Payment

Camp Salah Registration Fee

Price: $ 50.00

Payment Processing Fee

Price: $ 2.32

Total

$ 0.00

Stripe Credit Card *

Card

Name on Card