2020 MGC Kids Camp - Application
Application
MGC KIDS CAMP 2020
June 2-7, 2020 (Tuesday– Sunday)
Name *
Your answer
Date of Birth *
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Age *
Your answer
Shirt Size *
Address *
Your answer
Phone *
Your answer
Name of Parents *
Your answer
Parents Phone *
Your answer
Insurance Provider *
Your answer
Insurance Provider - ID number *
Your answer
Doctor’s name/Telephone *
Your answer
Last Tetanus shot *
Your answer
Are there Any medical conditions we should know about? *
If answered Yes: Are there Any medical conditions we should know about? EXTENT:
Your answer
List all medications brought to camp along with dosage & frequency: (All medications must be presenter to First Aid Staff on first day at check in. Medications must be in original container, labeled, with specific written dispensing instructions by parent/guardian or medical doctor. *
Your answer
If needed, May we dispense First Aid (including over the counter medicines) as required for illness and or injury? *
Any allergies? List any & all food, medicine, environment (insect stings, hay fever, etc) Other. Please describe below what camper is allergic to and the reaction seen. *
Your answer
Contact in case of emergency (other than parent): Name: *
Your answer
Contact in case of emergency (other than parent): Phone: *
Your answer
Parent/Guardian Authorization for Health Care: This health history is correct and accurately reflects the health status of the camper, I agree to allow him/her to participate in all activities that occur at MGC Kids Camp 2020. I realize that unanticipated and unexpected dangers may arise during and associated with the camp activities. I voluntarily agree to accept any and all risks of injury arising from the camp activities. By this agreement, I authorize MGCKids Camp 2020 Staff/Agent to administer First Aid (including over the counter medicines) as required for illness and injury. In case of an emergency, I authorize the leadership of this camp to administer emergency treatment to the above named camper. This agreement of the parent or guardian below is intended to serve as medical release. (SIGN BY ENTERING YOUR NAME AND DATE BELOW) *
Your answer
CAMP RULES
To make sure everyone has fun and is safe please do the following:
1. Do not bring any weapons or other devices that could injure yourself or other campers
2. Obey all 'Leoni Meadows Camp' rules
3. Respect all leadership/staff
4. Do not leave the campsite without permission
5. Have a positive attitude
AGREEMENT
I, (HAVE THE CHILD ENTER NAME AND DATE BELOW), agree to respect others and promise to be cooperative with the camp schedule. The child also promises to have an open heart and attentive ear to hear with what God has to say to him/her throughout this camp. *
Your answer
RELEASE
1. I, on behalf of myself, parent, and the child designated on the Form (MGC Kids Camp 2020 – “Camp”), waive and release all rights, causes of action and claims against (MGC Kids Camp 2020 – “Camp”), (Leoni Meadows Camp)/Missionary Gospel Church and their respective staff for any and all loss of or damage to property or injuries suffered by Parent/Child during the time my Child is visiting (MGC Kids Camp 2020 – “Camp”), (Leoni Meadows Camp), including the possible negligence of (MGC Kids Camp 2020 – “Camp”), Leoni Meadows Camp)/Missionary Gospel Church, but excluding gross negligence and intentional misconduct. I understand that the provision of my Child contains risk of injury to persons and damage to property, and that by signing this release, I engage (MGC Kids Camp 2020 – “Camp”), (Leoni Meadows Camp)/Missionary Gospel Church to provide temporary child care for my Child at my own risk. I represent that I am authorized to sign this release on behalf of the child(ren) listed. 

2. I have been given an opportunity to ask questions and obtain answers to my satisfaction regarding any and all aspects of (MGC Kids Camp 2020 – “Camp”), Leoni Meadows Camp)/Missionary Gospel Church and the Release, including, but not limited to, future risks, complications and costs. By signings this Release, I have not relied on any promises or statements made by (MGC Kids Camp 2020 – “Camp”), (Leoni Meadows Camp)/Missionary Gospel Church other than those contained in the written information supplied to me by (MGC Kids Camp 2020 – “Camp”), (Leoni Meadows Camp)/Missionary Gospel Church. 

3. I understand that this Release will be kept on file at Missionary Gospel Church. 

I HAVE READ THE ABOVE RELEASE STATEMENT CAREFULLY AND FULLY UNDERSTOOD THE CONTENT AND CONSEQUENCES OF THIS AGREEMENT BEFORE SIGNING. (SIGN BY ENTERING YOUR NAME AND DATE BELOW) *
Your answer
Payment Receipt Number - (After paying enter the Receipt Number/ID or enter "Paid with Cash") : *
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