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KIDS CAMP |
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REGISTRATION FORM |
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| All information is required. Form
must be signed by parent or guardian |
| Child's Full Name
__________________________________ Age ___________ |
| Birthdate________________ |
Address ________________ |
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| City ___________________ |
State/Zip________________ |
Phone__________________ |
| I will be attending another camp
this summer. YES NO |
| Name of Parent or Guardian
___________________________________________ |
| Emergency Telephone
__________________________ T-shirt Size ________________ |
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| There is a charge of $5.00 for this
camp payable on or before the first day of camp, which is:_July 16
through July 20th 9:30am to 3:30pm___ |
| Camp Permission : I give my
permission for my child to take part in this camp and my child |
| agrees to follow the "Rules of
the Camp" |
| Signature of parent or guardian
________________________________________ |
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| Please bring this form to the
Motley County Library, Matador, or the Dickens County Library, Spur; or
mail to |
| The application deadline is July
1st so please get your application in by then so we can plan for the
number of children attending and order the t-shirts. |
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| BUS PERMISSION: I give my
permission for my child to ride the school bus provided by his/her school
district. |
| Signature of parent
_______________________________________________________ |
| Known Allergies OR Other medical
concerns : _________________________________ |
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| MEDICAL PERMISSION : I, parent
or guarding of a minor child named ______________ |
| _________________________ do
hereby give consent for said minor child to participate |
| in all activities
scheduled as part of the Roaring Springs Kids Camp. I further give |
| permission to have emergency
first-aid administered by any qualified person in case of |
| illness and/or injury to said
minor child, and to have said child transported by the most |
| expedient means of conveyance to
the nearest available physician, hospital or clinic and to |
| there receive such treatment as
is medically prescribed by physicians. This authorization |
| extends to medicaldoctors,
nurses and any other person trained to administer emergency medical aid. |
| Signature of parent or guardian
________________________________________ |
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| *This camp will be at the Roaring
Springs Community Center, Roaring Springs , Texas |
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