YOUTH CAMP REGISTRATION:
Name:
_________________________________
Nickname:
_________________________________
Birth Date: ____ /____ /______
Age: ____ Male: ___ Female: ___
Address:
_________________________________
_________________________________
_________________________________
Telephone Number:
_________________________________
Emergency Number (s):
_________________________________
_________________________________
Parent (s) Names:
_________________________________
_________________________________
Parent Email and Phone
Number:
___________________________________
_______________________________
Things to Bring:
Bible
Sleeping Bag/Sheets
Pillow
Towel
Toiletries
Pen & Paper
AN OPEN MIND
No Drugs or Alcohol is allowed!
I, the undersigned parent and/ or
guardian of the child, whose name
appears below (hereinafter known
as “Participant”), hereby give my
consent for the delegate to attend
the Couples for Christ-Youth for
Christ Camp on November 6 to
November 8, 2009 at the Sacred
Heart Center.
The undersigned hereby
understands that the Sacred Heart
Center is a privately owned facility
and is covered by its own premise
and general liability and/or
responsibility, which is not covered
under the policy, held by the
mentioned facility.
The undersigned hereby
understands that each of the
delegates will be provided constant
adult supervision. All the
participants must be able to follow
directions, guidance, and
instructions in a proper manner at
all times. By signing below, I am
certifying that my child is well
behaved, responsible, willingly
accepts all rules and regulations
and follows instructions and
directions. I hereby authorize
Couples for Christ-Youth for Christ
to arrange for my child’s medical
attention, diagnosis, treatment, and
hospitalization and care in care of
emergency call, after an
unsuccessful effort has been made
to contact the undersigned
representative.
Couples for Christ-Youth for Christ
is therefore fully absolved and
released from any responsibility
and/or liability for my child while
engaged in any of the activities
within the scope of the program. I
agree and understand that I hold
harmless, Couples for Christ-Youth
for Christ from all or any liabilities,
costs, or damage to any property
caused by or arising out of my
child’s participation in this camp.