Faith Center Kids Camp

one application per child

Camper's Name

MaleFemale

Birth Date

Weight

Height

T-Shirt Size

Date of Last Tetanus

Special Needs (please explain)

Parent/Guardian Name

Address

Numbers
Home
Work
Cell

Email

Medical Information
Medical or other information we need to know. Please include any food allergies

Emergency Contacts
Name

Phone number

Name

Phone number

Permission to travel and authorization to treat
The camper listed above has my(our) permission to travel with Faith Center Church to Arrow peak Lodge and to participate in all camp activities, including swimming. Realizing there are certain risks involved with any camp activities, I agree to release, indemnify, and hold harmless Faith Center Church, Arrow peak lodge, the International Church of Foursquare Gospel, their leaders, director, employees, and volunteers for any losses, damages, or injuries arising out of or in connection with my child's participation In camp activities or in administering of emergency medical treatment. In the event of illness or injury, I authorize any member of the sponsoring, ministry team or Faith Center Church Camp Director to secure emergency medical treatment for my minor child. I also understand that my insurance plan will be primary for payment of any treatment that Is rend red to my child.

Signature of Legal Gaurdian

Date