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Friendship Baptist Camp

2023 Registration/Medical Release

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Camper Name __________________________________________________________ Phone #________________________

Home Address ______________________________________________________ Birthday ________________Age ________

City_______________________________________________________State ________________     Zip _________________

Email address: _____________________________ Parents' Names_______________________________________________

Church Name______________________________________ Church Address_______________________________________

Church Contact Person/Phone Number_______________________________________________________________________

Are you a Christian?   _________Yes  _________No   Do you know how to swim?     ________Yes  ________No

 

ALL MEDICATIONS MUST BE TURNED IN TO THE DIRECTOR!

No medicine is allowed with children!

**You must leave written instructions with the director/counselor for ANY medications or allergies!

Include name of medication, specific dosing instructions (before/after meals, with food/drink, etc.)!**

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Allergies?____________________________________________________________________________________________

       

Medications?_________________________________________________________________________________________

             

Other information:______________________________________________________________________________________

 

Emergency Telephone numbers:

Please list the name(s) and telephone numbers of relatives or friends who might be contacted in the event you can not be reached.

These people should be allowed to pick up your child from camp if necessary.

                   

                                   Name                                                                                                                           Phone #                             Relationship

            _____________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________________________________________________

                      

If my child should require medical attention and I am unable to be reached, I give permission for the camp director/manager to select a

physician and/or hospital for treatment.  I also give my  consent for the doctor and/or hospital   to treat, order injections,  anesthesia, or

surgery for ____________________________________ I further agree to assume responsibility for payment of services not covered

 by  my child's insurance.

 

 Parent Signature ___________________________________________________

 

Preferred doctor ______________________________________    Hospital _____________________________________

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