Registration Form RCAC Jr.

High Camping Trip

@ Alice Lake, July 14 – 16, 2006

Youth Information
First Name Last Name

eMail address

Parent/Guardian First Name Parent/Guardian Last Name

Home Phone Number

Parent/Guardian Phone Numbers (Cell, Work, etc…)

Gender Age Grade (in 2005-2006)

M F

Health Information
Health Card # Food or Other Allergies?

Emergency Contact Name (not Parent/Guardian) Emergency Contact Phone Number

Terms of Consent
1. As the parent/guardian of the child mentioned above, I grant permission for him/her to participate in the Jr. High
Camping Trip, July 14 – 16, 2006.
2. I expect the Church Staff and Fellowship Sponsors to provide responsible supervision. But I understand that
accidents can and do happen. As long as reasonable care is taken, I will not fault Richmond Chinese Alliance
Church, Church staff, or the Fellowship Sponsors for any injuries or loss of property that may occur during this
retreat.
3. If my child is injured, I authorize the Supervisors of the activity to take appropriate action, including administering
medical treatment by a first aid attendant or to authorize emergency medical personnel to act. In such emergency
requiring medical attention I expect to be notified immediately.

Parent or Guardian Signature:

Date (month day, year)