Bk Summer Camp 09




Bk summer camp 2009

bK Summer camp 2009 REGISTRATION FORM 175 Moolap station road Moolap PLEASE READ and PRINT CAREFULLY www.ballistikyouth.com E-mail- [email protected] Camper’s Name___________________________________________________________________________________________ _ Birth Date: ___/___/___ Gender: MALE or FEMALE Age (as of Jan 1, 2009): ________Grade 2009): ______ Mailing Address___________________________________________________________________________________________ City- __________________________________________________State- ___________Zip- ________________ Mother or Guardian- __________________________Father or Guardian ________________________________ Mum’s E-mail - _________________________________Dad’s E-mail _________________________________ Phone Numbers: Work # Mum (____)___________________ Work # Dad (____)___________________ Mobile # Mum (____)___________________ Mobile # Dad (____)___________________ Home # (____)___________________ Emergency # (____)___________________Ask for _________________ Attended a bK camp before? YES _____ NO _____ (THIS FORM MUST BE COMPLETE IN FULL AND MUST BE SIGNED) I, the undersigned, have read and understand the camp’s registration information. I give permission for Ballistikyouth and its leaders to seek any emergency medical treatment deemed necessary if unable to locate me. It is further agreed that as part of the consideration for the Camp to accept the above named child and for participation in all camp activities, The Camp shall not be liable for any damages whatsoever in the event of injury, illness of said child by any cause whatsoever, includeing its Leaders, and volunteers therewith of any such liability. I recognize that this is a Christian camp; that the Bible will be studied, and that camp conduct will be expected to be consistent with Christian values. I agree that any photos/videos taken at camp may be put in a album on the following ballistik webpages, Ballistikyouth.com, myspace.com/ballistikyouth and ballistikyouth’s facebook page. And these photos/videos may be shown at ballistik’s youth program. I give ballistikyouth staff permission to search backpacks and belongings if need be for the safety of all camp attendees. PARENT or GUARDIAN SIGNATURE DATE________ WITNESS FOR PARENT or GUARDIAN DATE________

Medical Details: Does your child have any health issues that we need to be aware. Please state all and any (This is so we can best care for your child. All details will be kept private and confidential) _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ Does your child take any medications, if so what are they and will they need help to take them? _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________