2009 Mammoth Cave Restoration Field Camp

Application for the weeklong Aug. 3-7

Mail to: Roy Vanhoozer PO Box 1277 Lexington, KY 40588. along with check made payable to Roy Vanhoozer.

A full Refund will be issued for cancellations received on or before 7/19/2009. No refund thereafter.

 Name____________________________________________________

Address_________________________________________________ City__________________

State___________ Zip_____________ Home Phone(_____)______________

Age ______

(if you are under 18, a parent or guardian must also complete a parental consent form and an adult must accompany you at camp)

Grotto___________________________________ E-mail___________________________________

List any food allergies/preferences:______________________________________________

Please list any medical experience/knowledge you have that could help in an emergency/accident:

 ________________________________________________________

What are your plans for sleeping arrangements?

Marking bunkhouse does not guarantee a space. The bunks will be assigned in the order received. You will be contacted if we run out of bunks.

bunkhouse/house _______________________

camping _______________________

hotel/off site/other ______________________

Number of T-shirts __________@ $10.00 ea __________

Size(s) ____ ____ ____

Camp Fee $70.00 each __________

Total remitted __________

EMERGENCY CONTACT/MEDICAL INFORMATION

The emergency contact information must be completed. All information is confidential.

In case of emergency contact: __________________________________

Relationship:_____________________

Phone: (H)__________________________(W)_________________________

Address: _______________________________________________________

The information below is optional at your discretion, but could be beneficial in case of a medical emergency.

Do you have any of the following:

Allergies:_______________________________________________________

Chronic/Recurring illness:_______________________________________

Surgery/serious illness in the past year:________________________

Medications:_____________________________________________________

Heart or breathing problems:_____________________________________

Other:___________________________________________________________

Anything else EMT/medical personnel treating you should know:

 _________________________________________________________________

_________________________________________________________________