Bk summer camp 2009

bK Summer camp 2009

REGISTRATION FORM
175 Moolap station road Moolap
PLEASE READ and PRINT CAREFULLY www.ballistikyouth.com
E-mail- kontakt@ballistikyouth.com
Camper’s Name-
___________________________________________________________________________________________
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Birth Date: ___/___/___ Gender: MALE or FEMALE Age (as of Jan 1, 2009): ________Grade 2009): ______
Mailing Address-
___________________________________________________________________________________________
City- __________________________________________________State- ___________Zip- ________________
Mother or Guardian- __________________________Father or Guardian ________________________________
Mum’s E-mail - _________________________________Dad’s E-mail _________________________________
Phone Numbers: Work # Mum (____)___________________ Work # Dad (____)___________________
Mobile # Mum (____)___________________ Mobile # Dad (____)___________________
Home # (____)___________________ Emergency # (____)___________________Ask for _________________
Attended a bK camp before? YES _____ NO _____
(THIS FORM MUST BE COMPLETE IN FULL AND MUST BE SIGNED)
I, the undersigned, have read and understand the camp’s registration information. I give permission for
Ballistikyouth and its leaders to seek any emergency medical treatment deemed necessary if unable to locate
me. It is further agreed that as part of the consideration for the Camp to accept the above named child and
for participation in all camp activities, The Camp shall not be liable for any damages whatsoever in the event
of injury, illness of said child by any cause whatsoever, includeing its Leaders, and volunteers therewith of
any such liability. I recognize that this is a Christian camp; that the Bible will be studied, and that camp
conduct will be expected to be consistent with Christian values. I agree that any photos/videos taken at camp
may be put in a album on the following ballistik webpages, Ballistikyouth.com, myspace.com/ballistikyouth
and ballistikyouth’s facebook page. And these photos/videos may be shown at ballistik’s youth program. I
give ballistikyouth staff permission to search backpacks and belongings if need be for the safety of all camp
attendees.
PARENT or GUARDIAN SIGNATURE
DATE________
WITNESS FOR PARENT or GUARDIAN
DATE________
Medical Details: Does your child have any health issues that we need to be aware. Please state
all and any (This is so we can best care for your child. All details will be kept private and
confidential)
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Does your child take any medications, if so what are they and will they need help to take them?
_______________________________________________________________________________________________
_______________________________________________________________________________________________
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