Registration Form

SonRock Kids Camp Vacation Bible School

Children 3 years old (potty-trained or parent accompanied) to 5^th grade

Fountain of Life Christian Fellowship

July 19-23, 2010 9:45 am to 12:30

**Please send a confirmation e-mail with names & ages of children to pastoraimee@folfonline.com by July 1^st

Please bring this completed form to check in on the first day of VBS.

Child’s Name:__________________________________Boy________Girl________

Age:_______________________ Date of Birth:_________________

Street Address:______________________________________________________

City, State, Zip:______________________________________________________

Home Telephone Number:_________________________________________

Parent/Caregivers Cell Number: _________________________________________

Home e-mail address:_________________________________________________

In case of emergency, contact: 1st__________________________________________________________

2^nd___________________________________________________________

Mother:_______________________ Father: ________________________

People Authorized to pick up child (including parents):____________________

_______________________________________________________________

Please contact Aimee Lawson, VBS director, with any questions (480) 857-0516

Permission to Participate and Release of Liability

I give permission for my child, _______________________, to participate in the activities of the Fountain of Life Fellowship Vacation Bible School during July 19-23. Further, I consent and agree to indemnify and hold harmless Fountain of Life Christian Fellowship, their agents, employees, or volunteer assistants from all claims that I or they may have arising out of my child’s participation in this program which is over and above that which is covered by insurance.

Parent(s)/Guardian(s) Signature____________________________________________

Emergency Medical Care and Treatment

If it should be necessary for my child to receive medical treatment for any reason, I understand that the medical insurance policy for Fountain of Life Christian Fellowship acts in primary position only when the participant is not already covered by insurance. Consequently, I agree to submit all claims first to my insurance company and then to the insurance company for Fountain of Life Christian Fellowship.

I also accept full responsibility for the cost of medical treatment for any injury suffered while taking part in the program which is over and above that which is covered by insurance.

In addition, I authorize and consent to all medical, surgical, diagnostic, and hospital procedures as may be performed or prescribed by a physician to safeguard my child’s health, and it is not advisable to take the time to contact me in advance. I waive my right to informed consent for such treatment.

Moreover, I understand that temporary emergency measures may be necessary to safeguard my child’s health, and I do hereby authorize and request Fountain of Life Christian Fellowship personnel to administer or supervise such treatment and to do any procedure they deem necessary until such time as my child can be safely transported to a doctor or hospital.

Parent(s)/Guardian(s)Signature ________________________________Date___________

Name & phone number of my child’s Physician______________________________________

Name, address, & membership/Group/Policy numbers of your medical insurance _______________________________________________________________________

Current medications_______________________________________________________

Known allergies____________________________________________________________