2008 Vacation Bible School

Hillcrest Church of Christ

June  2 - 6, 2008

REGISTRATION (Rising 6th thru 9th grades)

 

 

CHILD’S INFORMATION

 

First Name         Middle Initial    Last Name        

Address         

             City        Zip/Postal Code

 Age                DOB:  Month         Day        Year          Grade In Fall 2008    

 T-shirt Size      

 

BEHAVIOR INFORMATION

Does the child exhibit any behavior of which staff should be aware of? (i.e. fear of insects, shyness, or tantrums)

 

 

If so, what suggestions would help the staff effectively deal with behavior?

 

List any activities to be restricted:

 

MEDICAL INFORMATION

Please list any allergies or medical conditions the child may have:

 

Current Medication (Include instructions if medicine is to be administered at camp):

Medication                                  Dosage                               Time(s)

           

           

 

Doctor’s Name      Phone

Dentist’s Name      Phone

 

Which over-the-counter medications will you ALLOW the Camp Director or staff to administer to your child as needed?

       Tylenol                  Ibuprofen              Benadryl                 Mylanta

 

Special dietary needs

 

PARENT(S)/GUARDIAN INFORMATION

Mother/Guardian

First Name             Last Name          email:

Home Phone       Work Phone   Alternate Phone

Address (If different from child's)             

             City        Zip/Postal Code

 

 

Father/Guardian

First Name       Last Name   email:

Home Phone  Work Phone Alternate Phone

Address (if different from above)

           City      Zip/Postal Code

 

If parent/legal guardian is not available in an emergency, contact

Emergency Contacts

Name                                                                        Phone

                 

                 

 

 

PICK UP AUTHORIZATION

(Picture ID must be presented when picking up a child)

My child can only be released to the following person(s) without additional consent from a parent or guardian: 

Pick up Authorizations

Name                                                                           Relationship                                         Phone                                                               

                             

                             

 

 

 

 

CAMP POLICY and PARENT’S/GUARDIAN’S AUTHORIZATIONS:

I understand that the children I am registering, while participating in the Hillcrest Church of Christ VBS Camp, will be expected to follow a code of conduct requiring respect for rules, staff, volunteers, other persons, and property.

I grant permission for photographs of my child to be used for camp advertising.

I grant permission to Camp Director and Staff to administer minor medical emergency aid or treatment which they deem appropriate for my child.

I hereby give permission to the medical professional(s) selected by Hillcrest Church of Christ VBS Camp to order X-rays, routine tests and treatment for the health of my child, and in the event I cannot be reached in an emergency.

I hereby authorize and permit said minor to participate in the camp and hereby waive and release all claims for damage and loss to person property of said minor and; /or the undersigned which may be caused by any act of failure to act, of Hillcrest Church of Christ VBS Camp, its elders, deacons, ministers, volunteers or employees, and assume all risk of possible injury and damage which may result on account of such participation.

Name of person completing this form      

I have read and agree to the above terms and conditions:

 

Camp Registration Fees: Rising 6th - 9th grade  fees are $40 per camper

Application Deadline: May 4, 2008 and the registration fee is non-refundable after May 4, 2008.