Middler Experiences Registration Question Title * 1. What camp(s) are you registering for? Middlers In Mission - San Francisco - June 10th-13th Middler Camp - Lotus, CA - July 8th-12th Question Title * 2. Youth #1 Name (First and Last) Question Title * 3. Youth #1 Gender Male Female Non-binary Question Title * 4. Youth #1 Birthday (Month/Day/Year) Question Title * 5. Youth #1 Grade in Fall '19 6th 7th 8th 9th Question Title * 6. What is youth #1 t-shirt size? Small Medium Large Extra Large XXL XXXL Question Title * 7. #2 Youth first and last name Question Title * 8. Youth # 2 Gender Male Female Non-binary Question Title * 9. Youth #2 Birthday (Month/Day/Year) Question Title * 10. Grade in Fall '19 6th 7th 8th 9th Question Title * 11. What is youth #2 t-shirt size? No youth #2 Small Medium Large Extra large XXL XXXL Question Title * 12. Parent Contact Information Address Address 2 City/Town State/Province ZIP/Postal Code Email Address Phone Number Question Title * 13. Emergency Contact Information (in case parent/guardian cannot be reached) Name Phone Number Question Title * 14. Is your child allergic to any foods or medications? Please list all that apply. Question Title * 15. Please list all medications your child may be taking. Please list inhalers, epipens, pills, etc. Question Title * 16. If your child is taking any medications, are they able to be self-administered? Yes, my child can be responsible for their own medication. Yes, but an adult needs to remind my youth to take the medicine. No, an adult should be responsible for ensuring the medicine is administered and taken properly. Does not apply Question Title * 17. Insurance Information (Company Name) (Policy Number) (Group Number) (Name of Primary) Question Title * 18. Photo release Yes, I give Los Gatos UMC and Central UMC permission to take photos of my child that may be shared between families who attend the trip, used on social media (without names), or in promotional information (without names). No, I do not give Los Gatos UMC and Central UMC permission to take photos of my child that may be shared between families who attend the trip, used on social media, or in promotional information. I'm not sure. Question Title * 19. Permission to transport my child(ren) Yes, I give my permission for staff and/or volunteers from Central UMC or Los Gatos UMC to transport my child to, from, and around camp. Question Title * 20. Can parent and youth attend a information meeting on Sunday, June 2nd? Yes, both child and parent can attend Only parent can attend Only youth can attend No one from our family can attend Done
