NEW HOUSE FARM, EAST DEAN, WEST SUSSEX Pioneer Christian Camp 2000

 

Name:______________________________   Date of Birth:_______________

Boy or Girl?__________   Age on 1st September 2000:__________

Address: __________________________________________________   __________________________________________________   __________________________________________________   Postcode:_______________   Telephone:____________________   Height in metres please (for team games):_______________   I Wish to attend [  ]  Camp 1: Tuesday 1st August to Friday 11th August 2000   [  ]  Camp 2: Tuesday 15th August to Friday 25th August 2000   If possible, I would like to be in a tent with:_____________________________ (one name only)   Recommendation of Pastor/Youth Leader Please ask your Pastor or Youth Leader to complete and sign this part of the form.   Name:_______________________________ Pastor/Youth Leader (delete as appropriate)   Address: __________________________________________________   __________________________________________________   __________________________________________________   Postcode:_______________   Telephone:____________________   Camper's Church:________________________________________   I recommend that _______________________________ be accepted for the 1st/2nd Camp (delete as appropriate)   Signature:______________________________   Parents' Approval I fully expect that my child will be able to attend camp and I am willing for him/her to do so. I give my consent for the Leader to take whatever disciplinary action is necessary to ensure that the simple rules which are laid down for the well-being of the campers are kept. I consent to him/her swimming with proper supervision. I delegate my authority for any medical attention which may be necessary for my child to the Camp Leader, including the use of anaesthetics.   Family Doctor's Name:______________________________   and address: __________________________________________________   __________________________________________________   __________________________________________________   Telephone:____________________   National Health No:______________________________   Is Tetanus cover up to date?_______________   Please give details of any medical conditions which we should be aware of, including allergies, asthma, etc, together with any special diets (e.g. vegetarian):         The Camp Committee may have to limit the number of campers and reserves the right to refuse any application. Signature of Parent/Guardian:___________________________________   Date:____________________   Please print name and initials below for any reply: Mr/Mrs ________________________________________

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