BTMP Registration Tribal Assistant
BibleTimes Marketplace 2013 June 10-14, 2013
Registration deadline is May 17. 2013. IPC members have first priority until April 17, when registration will open to non-members. Due to camp capacity, registration is limited to 135 campers. Please register early to secure your youth's place at BTMP.
Please complete a separate form for each youth.
Please fill out the entire form. The information is important to help us supervise and care for your youth.
Form for Tribal Assistants:
Parent's Email Address:
Youth Grade completed:
Are you or your family a member of IPC? Yes No
If not a member, other church affiliation
Have you previously attended BTMP? Yes No
Have you previously been a Tribal Assistant at BTMP? Yes No
Is there someone you hope to be grouped with?
Is there a specific Tribal Mother you hope to help?
YOUTH: I have read and understand my duties as a Tribal Assistant Yes No
ADDITIONAL INFORMATION TO ASSIST THE STAFF:
Are there any special concerns about your youth that the staff may need to know?
Mother's cell phone:
Father's cell phone:
Emergency Contact/Relationship (in case mother or father cannot be reached):
Emergency phone number:
: Emergency cell number
Registration Fee: (Scholarships available)
$35 for each youth, includes tee shirt
$25 if your youth requires bus transportation
$8 Dinner/Fun Night at IPC, Wed., June 12 (optional)
Total amount of your check:
Checks go to Sally Speaker at IPC
Tee Shirt Size Needed:
Youth: Medium Large
Adult: Small Medium Large
Parents: Will your youth need bus transportation to and from IPC to the CFAF?
Parents: If "No Transporation Needed," please indicate who may pick up your youth from CFAF in the afternoon:
Name of person allowed to pick up youth:
Special health problems and/or allergies for this youth:
Medication to be given during camp hours (please give dosage and time on a clearly labeled container with your youth's name):
Name of Policy Holder:
Insurance Co/Group or Policy Number:
PERMISSION: MUST HAVE SIGNATURE
NOTE: After you click "Submit" below, you will be directed to a signature page.
On that page, you must click on the short document, print it, and sign (handwritten) the brief signature page.
After signing that form, please give that hand-signed form and your check to Sally Speaker.
NOW, CLICK "SUBMIT" to send all of the above information to Sally Speaker