C A M P     M E A D O L A R K     A P P L I C A T I O N
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         Name _____________________________________________________

      Address _____________________________________________________

         City _____________________________________________________

    State/Zip _____________________________________________________

    Day Phone _____________________________________________________

Evening Phone _____________________________________________________

               Name and phone numbers for emergencies

1)_________________________________________________________________


2)_________________________________________________________________



Height: ______		Weight: ______		Age: ______


Shirt Size:[  ]Sm	[  ]Med		[  ]Lg		[  ]XL


     School attending: ____________________________________________


Grade level next Fall: ____________________________________________


[  ]1 Day Clinic	[  ]1 1/2 Day Clinic	[  ]Coaches Clinic

[  ]2 Day Camp		[  ]3 Day Camp		[  ]5 Day Camp


Return with $50.00 deposit or full amount. Make check payable to:

	Meadowlark Lemon Ministries
	13610 N. Scottsdale Road Suite #10267
	Scottsdale, AZ 85254
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			FOR OFFICE USE ONLY
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   [  ] Deposit     [  ] Full Payment        Check# ________________


Amount ____________   Date ___________________________


Bank ______________   City ___________________________   State _____


Paid in full: Y / N   Bal Due ________________________   Cash ______





	   CAMP  MEADOWLARK  MEDICAL  RELEASE  FORM
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I grant my son/daughter permission to attend Camp Meadowlark.

I realize that injury or illness could result from or during 
participation in the camp/clinic and I hereby give my consent 
for medical treatment and permission to the attending physician 
to hospitalize, secure treatment and order injections, anesthesia 
or surgery as deemed appropriate. I will assume responsibility for 
medical and other charges in connection with my son’s/daughter’s 
attendance at camp/clinic. I further acknowledge that Camp 
Meadowlark, its owners, its coaches, or the facilities and anyone 
associated with the camp/clinic will not be liable for and damage 
from injuries or illness sustained at the camp.

I understand that no one will be permitted to attend camp/clinic 
without insurance and certify that my son/daughter is covered by 
medical insurance.


Applicant’s Insurance Company: _____________________________________


		Policy Number: _____________________________________


Any restrictions on participation/medical problems?  Y  /   N


If YES, explain: ____________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________


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Parent or legal guardian:
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Print Name: ____________________________________________________

 Signature: ____________________________________________________

      Date: ____________________________________________________
    
     Phone: (     )__________-__________________________________