Registration form for camp grace “grace for life”

Registration Form for Camp Grace Junior Camp June 12 – 15, 2012

Please print neatly on both pages!
Last name: ___________________________ First: _____________________ Age: _____ Male/ Female
Address____________________________City______________________State_____ Zip Code_________
Date of birth ___/____/___ Grade this coming year___ Parents’ names: ____________________________
Home phone (____) _____________________ Work phone (____) _________________
Camper Health Form
In case of Emergency: Other persons to notify if parents cannot be reached:
Name______________________________________ Relation________________ Phone: _____________
Name______________________________________Relation_________________Phone: _____________
Past Illnesses: (please circle any that the child has had)
Diphtheria Whooping Cough Scarlet Fever Chicken Pox Mumps
Polio Rheumatic Fever Tuberculosis Other: _______________
Existing Diseases or Conditions: (please circle and explain current condition)
Sinus Asthma Heart Kidney Epilepsy Diabetes
Current Condition/Treatment: ________________________________________________
Does the child have any significant history of the following: (please circle)
Nose bleeds Headaches Sleep walking Fainting Sore Throat
Diarrhea/ Constipation Frequent colds Other: _________________________________
Allergies: (please circle and specify)
Penicillin Bee/wasp stings (specify treatment) _________________________________
Other: __________________________________________________________________
Immunization Record:
(Record last date of injection.) Tetanus_________________ Polio_______________
Diphtheria___________ Whooping cough_______________ Smallpox___________________
Insurance Information: (please complete fully)
Company____________________________ Name of holder___________________
Policy #_____________________________ Group #_________________________
In case of emergency: I give permission for my child to be given over-the-counter medicine(s) for minor
ailments. I also give permission for my child to be transported to, and treated at a medical facility in the
event of an emergency.
________________________________ __________________
Signature of parent or guardian) (date)


Consent and Release Form
I, the undersigned parent or guardian, hereby consent to my child’s participation in the “Camp Grace
Junior Camp.”
This includes the transportation of my child to and from certain excursions that the camp
will participate in. I certify that my child is able to participate in all activities
I will assume full responsibility, including all costs, if my child should need to be transported home,
including for disciplinary reasons.
If my child has medical conditions which may be relevant to a physician in the event of an emergency, I
have listed them on the health form. In the event an emergency occurs, I may be reached at the telephone
number provided above. If I cannot be reached, I herby authorize the adult sponsor in charge to make
emergency medical decisions for my child. I understand and hereby agree to assume all of the risks which
may be encountered on said activity, including activities preliminary and subsequent thereto. I do hereby
agree to hold Freddie Coile, Focus Evangelistic Ministries, Grace Farm, and their agents harmless from any
and all liability, actions, causes of actions, claims, expenses, and damages on account of injury to my child
or property, even injury resulting in death, which participant now has or which may arise in the future in
connection with the activity or participation in any other associated activities.
Permission is granted for the use of images or recordings that may include my child for promotional
I expressly agree that this release waiver, and indemnity agreement is intended to be broad and inclusive as
permitted by the law of the State of Georgia and that if any portion thereof is held invalid, it is agreed that
the balance shall notwithstanding continue in full force and effect. This release contains the entire
agreement between the parties hereto and the terms of this release are contractual and not a mere recital.
I further state that I have carefully read the foregoing release and know the contents thereof and I sign this
release as my own free act. This is a legally binding agreement which I have read and understand.
____________________________________________________________ _____________________
Parent or guardian’s signature

____________________________________________________________ _____________________
Witness signature

* Electronic Devices Policy: Electronic devices are not allowed at camp. Camp is a life-changing
experience that is better without distractions. Do not bring electronic devices to camp. If a parent
desires cell phone contact with a child this is allowed if the phone is turned in to the Happy Shack
and calls may be made daily during a time when the Happy Shack is open.
Mail registration with payment ($95) to:
Focus Evangelistic Ministries
2694 Hwy 174
Danielsville GA 30633


Microsoft word - 2004 pre pesach guide.doc

Rabbi Spolter’s Pre-Pesach Guide Pesach Product Guide On Pesach, the Torah commands us to rid our homes of all chametz. Not only is one forbidden to eat chametz on Pesach – one is not allowed to own it, or even possess chametz belonging to someone else, on Pesach. What is chametz? Chametz is any food or drink made from or containing wheat, rye, barley, oats or spelt. When any

Estudo sobre as principais festas bíblicas

Estudo sobre as principais festas bíblicas Tipo: Teologia / Autor: Autores diversos "As festas bíblicas são ordens sagradas do Senhor. Elas não são apenas judaicas; são, antes de mais nada, do Senhor, declaradas como estatuto eterno (Lv. 23:1-44). Essas festas não são um convite para que a Igreja volte à primeira aliança, mas para sustentar a mensagem que elas transmitem. Elas apo

Copyright © 2011-2018 Health Abstracts