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Transformation Leaders Registration
June 1st - June 2nd 2025
Leaders Check-in June 1st 4:00 p.m.
Student Camp Check-in June 2nd 8:00 a.m. – 10:00 a.m.
Celebration Service (parent/guardian attend) June 5th 1:00 p.m.
Camp Departure June 5th 3:30 p.m.
Leaders Final Clean-up
Church Name
First Name
Last Name
Address
Apartment, suite, etc.
City
State
Zip/Postal Code
Birthdate
Month
January
February
March
April
May
June
July
August
September
October
November
December
Date
1
2
3
4
5
6
7
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10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
Year
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
Gender
Male
Female
I'd rather not say
Email
Cell Number
Work Number
T-Shirt Choice
Adult Small
Adult Medium
Adult Large
Adult X-Large
Adult XX-Large
Desired Position Choice 1
Choice 2
In the event of an Emergency Contact......
Name
Relationship
Emergency Contact Number
I agree to attend the entire Transformation Camp 2025 as a leader, allow a background check to be ran, take on expected responsibility, release the camp and/or staff from any liability, and acknowledge that all above questions are answered honestly.
Signature of Leader
Date When Signed
Month
January
February
March
April
May
June
July
August
September
October
November
December
Date
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
Year
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Leader Medical History
Health Insurance Company
Policy Number
Group #:
Date of last Tetanus shot
Month
January
February
March
April
May
June
July
August
September
October
November
December
Date
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
Year
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Do you suffer from any medical, physical, emotional, or behavioral conditions which might affect his/her safety while at camp? (e.g., claustrophobia, vertigo, asthma, heart condition, diabetes, epilepsy, etc.)
Yes or No
Yes
No
If yes Please Specify
Are you currently undergoing any form of medical psychological treatment, including medication?
Yes or No
Yes
No
Is any daily medication required?
Yes or No
Yes
No
If yes please specify.....
Will you be bringing any prescription or non-prescription medication to camp?
Yes or No
Yes
No
If Yes, please attach list of medication and dosing schedule. This MUST be turned in at Check-In the first day of camp or mailed in with your registration form
Are you allergic to any food or any medication or insect stings?
Yes or No
Yes
No
If yes please specify.....
List any surgeries or Serious injuries in the last 2 years
Doctors Name
Phone Number
.Have you ever been charged with/convicted of felony?
Yes or No
Yes
No
.Have you ever been charged with or convicted of any crime involving a sex offense, an assault, or the use of a weapon?
Yes or No
Yes
No
Have you ever been charged with or convicted of any crime involving the use, possession or the furnishing of drugs or hypodermic syringes?
Yes or No
Yes
No
Have you ever been charged with or convicted of reckless driving, operating a motor vehicle while under the influence, or driving to endanger?
Yes or No
Yes
No
If yes to any of the above questions, please explain on separate sheet
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