Seed Cloud Summer Camp – July 12-16, 2010 MEDICAL, LIABILTY RELEASE AND INFORMED CONSENT FORM Student’s Gender: Date.

 

FirstName: LastName: DateofBirth: Age: Gender:MF Address: Apt : City: State: ZipCode: HomeChurch: Campmate Request: Custody: Mother Father Both.

 

Tel: 408 445-2118 Fax: 408 445-2151 www. com Lighthouse Project2013 RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT In CONSIDERATION of the acceptance of the application for entry into.

 

FIRST BAPTIST CHURCH DAYCAMP 620 Fourth Street Graham, TX 76450 940-549-2360 FOR SEPTEMBER 1, 2009 Ð DECEMBER 31,2010 HEALTH AND REGISTRATION INFORMATION.

 

620 Fourth Street FOR SEPTEMBER 1, 2010 –DECEMBER 31, 2011 HEALTH AND REGISTRATION INFORMATION Child’s Name: Sex: Address: City: Zip: _____________.

 

FIRST BAPTIST CHURCH DAYCAMP 620 Fourth Street Graham, Texas 76450 940-549-2360 FOR JANUARY1, 2012 - DECEMBER 31,2012 HEALTH AND REGISTRATION.

 

Revison: June2003 Summer Camp Medical PermissionForm Adirondack Scout Camps Sabattis Scout Reservation Camp Portaferry Long Lake,.

 

CAMPER NOTE: Failure to sign this form will prohibit your child from participating in all Eagle Bluff activities. All medical.

 

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CAMP RELEASE, INDEMNIFICATION AND MEDICAL PERMISSION 7KLV 5HOHDVH ,QGHPQLILFDWLRQ DQG 0HGLFDO 3HUPLVVLRQ JUHHPHQW WKLV ³ JUHHPHQW´ LV HQWHUHG LQWR WKLV.

 

LACROSSECAMP MEDICAL RELEASEFORM ALL PLAYERS PARTICIPATING MUST PROVIDE THIS FORM Function: 3DUWLFLSDQW¶V 1DPH : _________ ______ _____ __ _____.

 

- arts. org PO Box 366, Boone, NC F:828-262- 4599 c hristy watauga - arts. org Watauga Arts Council Summer ArtsCamp, June20-25 ,2011 Parental.

 

Parental Permission and Release I, parent’s name as parent/legal guardian of child’s name hereby give my consent for participation in the Summer Arts Camp,.

 

RELEASE FROM RESPONSIBILITY PARTICIPATION IN SCHOOL/CHURCH ACTIVITIES In consideration of my child, being permitted to participate in school and church related trips, athletic.

 

Must be filled out and signed before participation Basic Information Child’s Full Name: Parent/Legal Guardian Name s : Home Home Phone.

 

MEDICAL RELEASE FORM FOR CAMP IRON HORSE Date__________ Date________ Signature of Parent or Guardian Camper.

 

Organic School Summer Art Bash Program Registration and Medical Release Please note: Registration Form will be keep on file for ALL future.

 

Medical ReleaseForm Parent/Guardian Address Home Phone ____ Work Phone ____ Cell Phone ____ Other Phone ____.

 

Name of Church Spring Baptist Church - Spring, TX Date Gender M _____ F _____ Participant’s Name Address Zip _______ Home Phone.

 

Must be filled out and signed before participation Basic Information Child’s Full Name: Parent/Legal Guardian Name s : Home Home Phone.

 

Parental Permission and Release I, parent’s name as parent/legal guardian of _________ child’s name hereby give my consent for participation in the Summer Arts.

 

I, parent’s name as parent/legal guardian of child’s name hereby give my consent for participation in the Summer Arts Camp, featuring Missoula Children’s.

 

Parks Recreation Department CAMPER MEDICATIONFORM CONFIDENTIAL RECORD - EXEMPT FROM PUBLIC DISCLOSURE Please complete the following Please Print.

 

60 S Lincoln Street, Washington, PA 15301 724-250-3330 Washington Jefferson College/IU1 Center for STEM Education for CAMPTech Dear Your child’s picture.

 

60 S Lincoln Street, Washington, PA 15301 724-250-3330 Washington Jefferson College/IU1 Center for STEM Education for CAMPTech Dear Your child’s picture.

 

New Canaan Recreation Department YOUTH CAMP HEALTH EXAM/REC ORD FOR CAMPERS AND STAFF Physical Exams Are Valid for 3 Years From Date of Last.

 

Pastor Dave Richardson: dave. com 253. 205. 5210 1 REACH/IMPACT Medical Release Summer Camp EFFECTIVE DATES: August17-21, 2008 CONSENT TO TREAT.

 

SUMMER CAMP INFORMATION AND HEALTH HISTORY FORM GREENBURGH NATURE CENTER 99 Dromore Road Scarsdale, NY 10583 914-723-3470 Telephone 914-725-6599.

 

PLEASE COMPLETE ALL INFORMATION ON EACH FORM. Although it seems repetitive to you, the forms are processed separately; so we need the information o n each sheet.

 

Summer Camp Registration -2011 Camper: … Beginner … Novice … Advanced Parent: Address: Camp Sessions de- posit due with each child’s.

 

301 459-7311 Fax 301 459-2813 ages7-11Fees 180 Per Week 360 Total ȹ UWV UDIWV Animation 7/5-7/8 4 days Fees Arcade Games 7/11-7/15 5 days 125 per week 15 hours.

 

Form130D University of Texas Arlington Health Services Box 19329 605 S. West St. Arlington, TX 76019 T. 817. 272. 2771 F. 817. 272. 3829 www. uta. CONSENT FOR TREATMENT OF A MINOR WHO DOESNOT.

 

SUMMER CAMP MEDICAL HISTORY FORM A PHYSICAN MUST COMPLETE THIS FORM 1. Number of s : 2. Reason for last and approximate date of YES NO COMMENTS.

 

Summer Camp Registration - Medical Information Please Print and Complete - One Form Per Child CHILD’S NAME: AGE: _________ MEDICATIONS: Please.

 

Kokushikai Judo Camp Medical Release Authorization Form.

 

FLINT HILL FIREDEPT ÒLEADING THE WAYÓ PHONE 803 548-4805 FAX 803 548-4901 1950 HWY 21 BYPASS FORT MILL, SC 29715 CHIEF - DAVID JENNINGS.

 

YOUTH PLAYER REGISTRATION FORM This form must be retained by the club for at least five 5 years or he player’s 18th birthday, whichever.

 

International SummerCamp Host Family Application Form Hosting Dates: July 17, 2012 to July 31,2012 Please email completedform by July.

 

Returnboth forms along with your payment in full to Camp Lee, 70 Camp Lee Main Road, Anniston, Alabama 36207. Day Camp.

 

INDIVIDUAL PARTICIPANT RELEASE I, the undersigned, being allowed to use the facilities of Saint Leo University Women’s Soccer Academy hereinafter “Academy” held on the campus.