2009 Beach Freeze Registration

Registration Information



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Name___________________________________

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Age _______ Grade _________ Gender________

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Shirt Size (please circle one): S

M

L

XL

Address _________________________________

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City ____________________ Zip ____________

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Parent’s Names ___________________________

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Phone # ______________

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Alternate Contact _________________________

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Relation ________________________________ Phone # _____________ Work # ____________

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Line up! It’s time for...

This side you keep so you have the packing list and all the info!

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MEDICAL INFORMATION:

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Allergies: ________________________________

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Medication Being Taken: _____________________

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Physical Handicaps or Limitations: ______________

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Medical Insurance Company: __________________

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Policy Number: ___________________________

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Member’s Name: __________________________

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Primary Physician: _________________________

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Physician’s Phone# ________________________

This side you fill out and turn in.

!

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Harbor Covenant Church,

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5601 Gustafson Dr. NW

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Gig Harbor, WA 98335

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253.851.8450

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Go ahead and dance in the puddles... ...we’re excited too!

What you need to know | |

Return to HCC 4:00 Monday, Jan. 19th

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Cost:

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Early bird rate: $135 (sign up by 11/14) What was I thinking: $175 (after 1/1)

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(Scholarships available)

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What should I bring: Sleeping bag, Bible, warm clothes, spending money for shopping in Ocean Shores and two meals on the road, toiletries, towel, swimsuit (one piece), journal, friends, camera, sleeping pad!

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What shouldn’t I bring: Personal electronic devices (no cell phones, ipods, mp3 players, cd players, etc), weapons, drugs, alcohol, pets, expensive personal items.

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Medical Release I give permission for ______________________ to travel to “Beach Freeze” with Harbor Covenant Church (Gig Harbor, WA) Jan. 12-15, 2006. I hereby release Harbor Covenant Church, its staff and sponsors, from responsibility and liability for any injury and illness that my child may sustain during this activity. In the event of an emergency, I hereby authorize an adult leader of this activity, as an agent for me, to consent to any x-ray examination; medical, dental or surgical diagnosis; treatment; and hospital care as advised by a physician, surgeon or dentist (as appropriate) as listened to practice under the laws of the state/province where the services are rendered, either at the doctors office or in any hospital. I expect to be contacted as soon as possible. I also understand that if my child is disruptive, brings alcohol, drugs, weapons, causes any injury to themselves or others, or engages in any unacceptable behavior, I will be responsible to remove my child from this activity and transport them immediately back to Gig Harbor.

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Parent or Legal Guardian

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__________ Date

Photography Release The undersigned gives permission to Harbor Covenant Church to photograph his or her son or daughter and use the resulting photographs for any purpose that Harbor Covenant Church deems proper.

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Parent or Legal Guardian



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When should I sign up: Now! In an effort to keep this an intimate retreat, space is extremely limited. Registrations will be accepted in the order they are received. Once trip is full there will be a waiting list.

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How do I sign up: Complete the registration form, attach payment ($75.00 non-refundable deposit) and then place in the lock box outside the pod.

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Beach Freeze is your opportunity to soak in the goodness of God’s love and be replenished from the stresses of home.

Late bird rate: $150 (sign up by 12/31)

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The same stunning weather, beach football, board game bonanza, bowling, kites, acoustic worship, slick track Go-Karts, hot tub, and of course good ol’ fashioned home cookin’, along with ample amounts of time to do absolutely nothing.

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Every year when the tourists have left, when the sun refuses to heat the sands, and the snow birds have departed, Harbor Covenant Church descends upon Ocean Shores, WA like a Siberian jackal.

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Time: Leave HCC at 3:30 Friday, Jan. 16th

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When: January 16th-19th

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