MorningBibleCampRegistration - East London Anglican Ministries

Morning Bible Camp August 11-15, 2008 Permission Form Print off and deliver or mail to: East London Anglican Ministries 2060 Dundas St. E., London, ON N5V 1R2 519-451-7780 Name of Child: ____________________________________________________________________________ Address: _________________________________________________________________________________ Telephone:__________________ Birth Date: _____________ Last Grade Completed: __________________ Names of Parent(s) or Guardian(s): ___________________________________________________________ Cell Phone/Daytime Phone (if different from above): ______________________________________________ Alternate Person to Contact in Case of Emergency: ______________________________________________ Relationship to Child: ______________________________________________________________________ Name of Family Doctor: _______________________ Health Care Number: ___________________________ Home Church (if applicable): _________________________________________________________________
Allergies: Please specify as necessary Environmental:________________________ Bee Sting: ___________________________ Drugs: ______________________________ Food: _______________________________ Epi-pen: Y/N Medic Alert Tag: Y/N Special Dietary Requirements: ___________ _____________________________________ Vegetarian: Y/N Any medications: ______________________		Medical History Corrective Lenses: __________________________ Asthma: __________________________________ Diabetes: _________________________________ Heart Trouble: ______________________________ Epilepsy: __________________________________ Kidney Trouble: _____________________________ Toileting Concerns: __________________________ Fainting: ___________________________________ Operations: ________________________________ Hyperactivity/ADD: __________________________
Additional Comments: ______________________________________________________________________ _________________________________ has permission to attend Morning Bible Camp at ELAM. To the best of my knowledge, the above named person is in good health andhas not been exposed to any infectious diseases in the past four weeks. I understand that every precaution has been taken for the safety and good health of the participants. In the event of an accident or illness the organizers of the Morning Bible Camp (As For Me and My House Family Ministries and East London Anglican Ministries), their staff and volunteers are hereby released from liability. In the event that a participant requires special medication, x-ray, or treatment beyond that which is possible at MBC, every possible effort will be made to notify parts/guardians immediately. Charges for additional transportation or special care will be directed to parents/guardians. I understand that this form is confidential and will be used only for the purposes of our ministry to and with children and youth. Parent/Guardian's signature ________________________________________ Date: ___________________ Please Note: We videotape portions of our weekly activities. This tape will be made availalbe at week's end for a nominal cost to any parent who wishes to have a lok at the enjoyable camp their children attended. Please indicate if you would like to purchase one of these tapes. Yes! I'd like to order ____ (number) of copies.