APEX Registration

Roseburg Stake Serving Saints in the Umpqua Valleys

APEX 2021 Registration

Please complete the form below for each attendee to camp.

First Name(*)

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Last Name(*)

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eMail(*)

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Phone Number(*)

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Age as of December 31, 2021(*)

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Ward(*)

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Emergency Contact Name

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The name of someone not at camp to contact in case of an emergency.

Emergency Contact Phone

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Photo Release(*)

Yes, I give permissionNo, I do not

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Parent or guardian gives permission for their son to be part of the camp video. APEX video will be shown at gathering of parents and made available online.

Parent or Guardian Electronic Signature(*)

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Shirt Size(*)

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Allergies to food or medicine(*)

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Medication or Special Physical/Mental Health Considerations(*)

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Other

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Anything else we should be aware of: medications, physical limitations, etc. (This information will be kept confidential)