Howdy Ags, Thank you for taking time out of your day to complete Howdy Camp 2018's Membership Registration. We understand that you have provided some of the information requested by this webfrom in paper copy. This information will provide Aggie Transition Camps with an electronic copy that will make camp preparations and communication with Trinity Pines much more efficient. Once again, we thank you for both your time and commitment to the Mission & Values of ATC. If you are unable to answer certain questions in this form, please type "N/A" in the field. As always, we are here to assist you with questions or concerns you may have - contact our Director of Administration & Risk Management Alex Bregenzer at [email protected]. Thanks & Gig 'em, Director Staff 2017-2018 General InformationName * Required First Last Prefered Name * Required Name you would like on your nametag.Sex * Required Female Male Date of BirthMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Over Eighteen * Required Yes No UIN * Required Hometown * Required Classification * Required Freshman (U1) Sophomore (U2) Junior (U3) Senior (U4+) Graduate Student College of Major * Required- Select -Agriculture & Life SciencesArchitectureBush School of Govt & Public ServiceDwight Look College of EngineeringEducation and Human DevelopmentGeosciencesLiberal ArtsMays Business SchoolScienceGeneral Academic Programs/OtherMajor * Required What will your major be in the coming semester?Contact InformationCell Phone * RequiredHome PhonePersonal Email * Required Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Emergency Contact Name * Required Emergency Contact Phone * RequiredCamp InformationCamp Name * Required Position * Required Counselor Chair Director Shirt Size * Required Small Medium Large X-Large XX-Large Personal InformationFamily Physician Name * Required Family Physician Phone * RequiredHealth Insurance Provider * Required Health Insurance Policy Number * Required Health Insurance Phone * RequiredAllergies * RequiredList any allergies to drugs, food, insects, plants, etc.Medical History * Required Diabetes Asthma Heart Disease Epilepsy High Blood Pressure None If you have a history of any of the listed conditions, please check them.Medication Needs * RequiredList any prescription medications you are currently taking.Optical Issues Glasses Contact Lenses Check the boxes if you wear any of the listed items.Other Illnesses or Issues * RequiredPlease list any other illnesses or issues you might be facing that relate to camp.Special Services Required * RequiredPlease list any special services you may require due to an existing medical condition, physical disability, or any physical condition limition your activities.Dietary Restrictions * RequiredPlease identify if you have dietary restrictions, including, but not limited to, food allergies (even if listed above in allergies), religious observances, cultural requirements, etc.Auto InformationIf you do not have any of the below, please enter N/ADriver's License Number * Required Auto Insurance Provider * Required Auto Insurance Policy Number * Required Vehicle Make * Required (Ford, Mazda, Chevy, GMC, Ferrari, Mercedes...)Vehicle Model * Required (F-150, Civic, Gallardo, Enzo...)Vehicle Year: * RequiredVehicle Year * Required Vehicle Color * Required Licences Plate Number * Required