SUMMER BIBLE CAMP

SUMMER BIBLE CAMP

Registration Form

Monday, August 3rd-Friday August 7^th, 2009

9:30 a.m.-12:30 p.m.

Pre-school (age 4)-6^th grade

Volunteers 7^th grade and up

First and Third Churches of Christ, Scientist, Austin

Please fill out this form and return by July 15^th for pre-registration to church clerk, Cary Heroy, or Jeri Tippetts. Or mail to Cary Heroy at 15500 Belfin Dr, Austin, TX 78717.

Student/Volunteer ___________________Grade [Aug. 09] ____ T-shirt size___

Parents/Guardian ____________________________________________

Daytime Phone ___________________ cell phone____________________

Address ____________________________ City ____________ Zip ________

Email ______________________________________

Parent/Guardian Permission to Attend Activity

I give permission for ____________________________________________________________

to attend Bible Camp at First Church of Christ, Scientist, Austin, the week of August 3-7, 9:30 a.m. to 12:30 p.m.each day. I understand that the camp will include Bible-based activities, singing, crafts, skits, and snack/play time.

_______I give permission for my child/children to be photographed during the camp.

In the event of emergency, I hereby direct camp authorities to:

_____ Seek Christian Science treatment from a Christian Science practitioner listed in the Christian Science Journal. Name & phone # of preference: ____________________________

_____ Seek appropriate medical assistance.

Name & phone # of physician: _____________________________

In either case, camp authorities will exercise reasonable judgment in administering on-the-scene first aid and will notify the parent/guardian at the earliest possible time.

Alternate name & phone number to contact if I am unavailable:

______________________________________________________________

ANYTHING WE SHOULD KNOW ABOUT YOUR CHILD [diet, health issues, etc.]

Signature of parent/guardian______________________________________________