CALIBRATE JR HIGH CAMP - WAIVER
WAIVER & MEDICAL RELEASE FORM

July 21-24 Calibrate Jr High Camp ‘22

Costs: $200 Early Bird $220 Late Fee                    
DEADLINE: June 23rd Early Bird July 14th Late Registration

Activity:Calibrate Jr High Camp @ Ottawa Valley Pentecostal Camp
(876 Faught Rd, Cobden, ON K0J 1K0)                                    

Time: Thursday Bus Leaves Bethel @ 5:30pm Sunday: Pick up Time @ Bethel - 9:15pm

Chaperons: Pastor Mitch Pitt and the Jr High leadership Team

Questions? Please Contact Pastor Mitch: mpitt@bethel.ca
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Name of Child *
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Does your child have allergies
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Does your child have a life threatening allergy? *
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Please explain the life threatening allergy *
Is your child bringing any drugs with them? (antibiotics, ritalin , ventilator)
Does your child have emotional, behavioural, mental concerns or limitation that the staff should be aware of? *
Check if your child currently, or within the past three months has had any of the following:
Date of Last Tetanus Shot? *
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Pre-cautions are taken for the safety and health of your child but in the event of an accident or sickness, Bethel Pentecostal Church, its staff and volunteers are hereby released of any liability.
In the event your child needs special medication,  x-rays or treatment, the parents/guardian will be notified immediately.
In case of surgical emergency, I hereby give my permission for a physician selected by Bethel Pentecostal Church to hospitalize, secure proper treatment, and to order injection,  anesthesia, or surgery as named above. (your name below will serve as an electronic signature) *
Your child must be covered by Provincial Medical Insurance or an equivalent medical insurance.
*** Provincial Health Insurance Number *** *
Name of Family Physican *
Physician's Phone Number *
Signature of Parent or Guardian (if under 18) (your name below will serve as an electronic signature) *
Pastor Mitch Pitt - Student Ministries  Bethel Pentecostal Church 500 Viewmount Drive Nepean ON K2E 7P2  Phone - 613.816.1383  Email - mpitt@bethel.ca
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