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465 Coral Street
Kaka'ako, HI, 96813

Surrender 2019

Camp 2019 reg form (1).jpg
Name *
T-Shirt Size *
Address *
Parent/Guardian Name *
Parent/Guardian Name
Parent/Guardian Phone *
Parent/Guardian Phone
Emergency Contact Name *
Emergency Contact Name
Emergency Contact number: *
Emergency Contact number:
Waiver *
By Clicking the check box below, I hereby give permission to the Anchor International Church Camp Staff to administer any required medication or hospitalization deemed necessary in case of an emergency to ensure the best possible medication for my child. In addition, I authorize the Anchor International Church Camp Staff to transport the above registrant ,within regulations and safety, to activities involved during Surrender Youth Camp 2019. I Hereby release Anchor international church of all liability and claims in accordance to this waiver.