spalding 2010 reg
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8/9/2019 Spalding 2010 Reg
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Medical Release FormI give permission for ______________________ to travel to Camp Spalding with Harbor Covenant
Church (Gig Harbor, WA) Aug. 8-14th, 2010.
I hereby release Harbor Covenant Church, its staff and sponsors, from responsibility and liability for anyinjury and illness that my child may sustain during this activity. In the event of an emergency, I hereby authorize aadult 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 topractice under the laws of the state/province where the services are rendered, either at the doctors office or inany 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 them-selves or others, or engages in any unacceptable behavior, I will be responsible to remove my child from this activitand transport them immediately back to Gig Harbor.
Photography Release
The undersigned gives permission to Harbor Covenant Church to photograph his or her son ordaughter and use the resulting photographs for any purpose that Harbor Covenant Church deems proper(For further explanation,pleasecontact Jen Easton at the church ([email protected] or his cell 253-241-3760).
_____________________ ___________Parent or Legal Guardian Date
*Both sides of this form will need to be filled and checks will need to be made out to
Harbor Covenant Church with Camp Spalding in the memo lineThanks
What you need to know:
When Does Registration close? July 9thWho? For incoming 6th to incoming 8th gradestudents!When? Aug. 8-14th 2010Why? Because it is one of the best ways to meet low students in the youth group, meet the MiddleSchool Staff team, and bring a friend!
What should I bring? Bible, Sleeping bag, Money(for two meals on the road and the snack bar), a lijacket, toiletries, swimsuit (one piece only), towel,journal, pen, friends, camera (optional), pillow, flaslight.
What shouldnt I bring? Personal electronic devi(anti-social), weapons, drugs, alcohol, pets, expensipersonal items, or Spice Racks.
How much is it? $395. And like always, scholarsare available! You can pick up a form in the Youth
(Room 106) or online at www.hccfuel.com. If you hany questions, please call Jen Easton!
How do I sign up? Complete and detach the registion form, attach payment ($50 non-refundable deposit) and then place in the lock box outside the yopod (Room 106). Complete payment is due by Aug. 1
We will be headed out to Camp Spalding,located North of Spokane WA. Well havetons of stuff to do!
There is Swimming, Boating, Mountain Biking,Bible Studying, Rock Wall Climbing, DiscGolfing, Mountain Boarding, Cliff Repelling, aswell as having opportunities to do crafts,
watch skits and just taking time to restaround Gods amazing handiwork! They evenhave horses and lots plenty of lakeside activi-ties (like the zip line over the lake!). Not tomention great worship and speaker times!
Join us in what will prove to be an awesomeweek!
Sign up fast because this year, spots are
extremely limited! As soon as we are filledwe will add you to a waiting list and will do ourbest to get you there!
If you have any questions, please contact JenEaston at 253.851.8450 or email him at
Please fill out both sides of this
page! Thanks!
Harbor Covenant Church, 5601 Gustafson Dr. NW Gig Harbor, WA 98335 253.851.8450
P l e a s e D e t a c h H e r e P l e a s e D e t a c h H e r e P l e a s e D e t a c h H e r e
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8/9/2019 Spalding 2010 Reg
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HEALTH INFORMATION Yes NoAppendictis .................................................................. O O
Asthma ......................................................................... O O
Convulsions................................................................... O O
Diabetes ........................................................................ O O
Digestive problems........................................................ O O
Ear trouble...................................................................... O O
Emotional problems ...................................................... O O
Epilepsy......................................................................... O O
Heart trouble ................................................................. O O
Hernia ............................................................................ O OLung problem ................................................................ O O
Menstrual problem ........................................................ O O
Skin problem ................................................................. O O
Known allergy to:
Penicillin..........................................................O O
Insect Stings.....................................................O O
Food(s)............................................................O O
Other drugs......................................................O O
Type __________________________________
Surgery within last 2 years? ............................................O O
Type__________________________________________
Last Tetanus shot _______________________________
Swimmer? ........................................................................O O
Camper restrictions:
In case of emergency, I give my authorization to provide whatever
emergency care is necessary for my childs safety, and assume
primary responsibility for payment.
______________ _________Parent Signature Date
CAMP SPALDING REGISTRATION AND MEDICAL RELEASE
RegistrationName______________________
Age ____ Grade (In Fall)____ Gender ____
Shirt Size: S M L XL
Address __________________________________
City ______________________Zip ____________
Parents Names ____________________________
Phone # _________________________________E-mail Address____________________________
Alternate Contact __________________________
Phone # _____________ Work # _____________
MEDICAL INFORMATION:
Allergies: _________________________________
Medication Being Taken: _____________________
__________________________________________
Physical Handicaps or Limitations: _____________
__________________________________________
Medical Insurance Company: _________________
Policy Number: ____________________________Members Name: ___________________________
Primary Physician: __________________________
Physicians Phone# _________________________
Please fill out both sides of this page! Thanks!
August 8-14th
P l e a s e D e t a c h H e r e P l e a s e D e t a c h H e r e P l e a s e D e t a c h H e r e