TAC Ministerios ELIM Lilburn GA – Children’s Camp 2022 Please enable JavaScript in your browser to complete this form.Legal Guardian Name | Nombre del Gardian Legal *FirstLastLegal Guardian Email | Correo Electronico Guardian Legal *Legal Guardian Phone | Telefono Guardian Legal *Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeIn Case of Emergency Name | En Caso de Emergencia NombreIn Case of Emergency Phone Number | Encaso de Emergencia LLame al Numero *I consent to medical treatment for my child in case of emergency | Doy autorizacion para atencion medica para mi niño o niña, en caso de emergencia medica *YesNoMinors information | Informacion del menor 1. Child Name | Nombre del Niño o Niña *FirstLastChose One | Escoja Una *Niño | BoyNiña | GirlChild Age | Edad del Niño *Shirt Size | Tamaño de Camisa *S (Youth)M (Youth)L (Youth)XL (Youth)S (Adult)M (Adult)L (Adult)XL (Adult)Alergies | Alergias *YesNoIf you answer yes, please describe and explain all allergies, as well as medications. | Si contestastes que si, porfavor decriba y explique todos los medicamentos.Picture Upload of your Child | Suba Una Foto de su Hijo * Click or drag a file to this area to upload. 2. Child Name | Nombre del Niño o NiñaFirstLastChose One | Escoja UnaNiño | BoyNiña | GirlChild Age | Edad del NiñoShirt Size | Tamaño de Camisa S (Youth)M (Youth)L (Youth)XL (Youth)S (Adult)M (Adult)L (Adult)XL (Adult)Alergies | AlergiasYesNoIf you answer yes, please describe and explain all allergies, as well as medications. | Si contestastes que si, porfavor decriba y explique todos los medicamentos.Picture Upload of your Child | Suba Una Foto de su Hijo Click or drag a file to this area to upload. 3. Child Name | Nombre del Niño o NiñaFirstLastChose One | Escoja UnaNiño | BoyNiña | GirlChild Age | Edad del NiñoShirt Size | Tamaño de CamisaS (Youth)M (Youth)L (Youth)XL (Youth)S (Adult)M (Adult)L (Adult)XL (Adult)Alergies | AlergiasYesNoIf you answer yes, please describe and explain all allergies, as well as medications. | Si contestastes que si, porfavor decriba y explique todos los medicamentos.Picture Upload of your Child | Suba Una Foto de su Hijo Click or drag a file to this area to upload. 4. Child Name | Nombre del Niño o NiñaFirstLastChose One | Escoja UnaNiño | BoyNiña | GirlChild Age | Edad del NiñoShirt Size | Tamaño de CamisaS (Youth)M (Youth)L (Youth)XL (Youth)S (Adult)M (Adult)L (Adult)XL (Adult)Alergies | Alergias YesNoIf you answer yes, please describe and explain all allergies, as well as medications. | Si contestastes que si, porfavor decriba y explique todos los medicamentos. Picture Upload of your Child | Suba Una Foto de su Hijo Click or drag a file to this area to upload. Date / Time *DateTimeParent Name | Nombre del Padre *Legal Guardian Authorization | Autorizacion del Gurdian LegalSubmit
