Grace Bible Day Camp 2008

Registration

Child's Name:	Grade Completed:   Age:    Gender:  Boy    Girl
Address:	City:   State:   Zip:
Phone:	Emergency Phone:
Parent or Guardian Information Parent information: I am the parent of the above child. I understand that checking the boxes and filling in my information constitutes legal agreement and that I may be contacted to verify my agreement.
Name:
*Transportation Authorization
	I hereby give my permission and assume full responsibility for my child(ren) to participate in the Day Camp including transportation to and pickup from all activities and thereby release all workers of Grace Bible Day Camp and Grace Church of Mentor from any liabilities whatsoever. I also understand that no insurance will be provided.
	*NOTE: Transportation for activities of this event will be provided by responsible, licensed, adult drivers who are members of Grace Church of Mentor
Consent for Medical Treatment:
	In the event that reasonable attempts to contact a parent or guardian has been made without success, I give my consent for the administration of treatment deemed necessary by a licensed physician or dentist and the transfer of my child(ren) to any reasonably accessible hospital. The following are facts concerning my child(ren)’s medical history to which a physician should be alerted:
Refusal of Consent for Medical Treatment:
	I DO NOT give my consent for emergency medical treatment of my child(ren). In the event of an emergency, I wish the staff of the Day Camp to take no action or to do the following:
Fees
Cost is $10.00 per child, no more than $25.00 per family, payable on the first day of camp.