Jr

Registration Form

RCAC Jr. High Camping Trip @ Alice Lake, July 14 – 16, 2006

Youth Information First Name

Last Name

eMail address

Parent/Guardian First Name

Parent/Guardian Last Name

Home Phone Number

Parent/Guardian Phone Numbers (Cell, Work, etc…)

Gender

Age

M

Grade (in 2005-2006)

F Health Information

Health Card #

Food or Other Allergies?

Emergency Contact Name (not Parent/Guardian)

Emergency Contact Phone Number

Terms of Consent 1. As the parent/guardian of the child mentioned above, I grant permission for him/her to participate in the Jr. High Camping Trip, July 14 – 16, 2006. 2. I expect the Church Staff and Fellowship Sponsors to provide responsible supervision. But I understand that accidents can and do happen. As long as reasonable care is taken, I will not fault Richmond Chinese Alliance Church, Church staff, or the Fellowship Sponsors for any injuries or loss of property that may occur during this retreat. 3. If my child is injured, I authorize the Supervisors of the activity to take appropriate action, including administering medical treatment by a first aid attendant or to authorize emergency medical personnel to act. In such emergency requiring medical attention I expect to be notified immediately.

Parent or Guardian Signature:

Date (month day, year)