8TH GRADE BIBLE CAMP

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Cell Phone *

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Emergency Phone *

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By checking the box below, I hereby agree to fully cooperate with the sponsor(s) of this activity and to remember at all times – as demonstrated by my good behavior – that I am representing San Gabriel Academy, my family, and most importantly, witnessing for Christ. *

I Agree

Guardian Name *

First Name

Last Name

Cell Phone *

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Work Phone

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Physician Full Name *

First Name

Last Name

Physician Phone Number *

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By checking the box below, I the guardian agree to the following: If emergency service involving medical action or treatment is required and the parent/guardian cannot be reached, the parents/guardian hereby consent to the rendering of such medical service to the above named student as shall be deemed necessary in the medical opinion of the doctor rendering such service. Those attending my child/ward should know of the following conditions, drug allergies, medications taken daily, or other pertinent information: *

I AGREE