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Generic Medical Release Form

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Generic Medical Release Form
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This is an example of generic medical release form. This document is useful for studying generic medical release form.

Shared by: Pastor Gallo
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MEDICAL RELEASE FORM

(To be completed & signed by parents of ALL STUDENTS UNDER AGE 18.)



Child's Name Date of Age Allergies, Handicaps, Limiting Health Conditions, Medications,

Birth Reactions to Medications









The staff at the Louisiana Bahá’í School have my permission to obtain whatever medical care or diagnostic tests they

deem necessary for the well-being of my children, named above, while they are attending the Louisiana Bahá’í

School.



Parent/Guardian’s Address:____________________________________ Telephone:_________________

Emergency Contact Person:____________________________________ Telephone:_________________

Family Doctor:______________________________________________ Telephone:_________________

Dentist:____________________________________________________ Telephone:_________________

Medical Insurance Provider: ___________________________________ Policy Number:_____________



Parent Signature:_______________________________________________Date:___________________



FIELD TRIP PERMISSION

My children, named above, have my permission to participate in field trips and all other planned group activities

while they are attending the Louisiana Bahá’í School.



Parent Signature:_______________________________________________Date:___________________





SPONSORSHIP AGREEMENT



Each child under age 18 who attends the school without a parent or legal guardian must be accompanied by a sponsor

who will be responsible for the child's conduct and well-being. I _________________________

(Print Sponsor's Full Name) agree to be present at the child’s check in and be responsible for the behavior

and well-being of: (Print child/children's full name(s)):

______________________________________________________________________________________________

_____________________________________________________________________________________

in conformity with the standards of conduct of the Bahá’í Faith and the established rules of the Bahá’í School and the

Facility Management during the time the above named is/are in attendance at the Louisiana Bahá’í School from

November 11, 2004 to November 14, 2004.



Signature of Sponsor: ___________________________________________________



I hereby indicate my understanding and approval of the above sponsorship.



Parent: _____________________________________________________ Date:___________________



Student: ____________________________________________________ Date:___________________



Student: ____________________________________________________ Date:___________________

REGISTRATION FORM

Please fill out and return by November 5, 2004 to: Registrar Suzanne Bonnette

315 Highland Creek Pwy, Baton Rouge, LA 70808

Pre-registration with payment is preferred. To assure an advance sleeping arrangement payment is required.

Please make check payable to Louisiana Regional Bahá'í School. This allows us to know how many people are

planning to attend the school thus we can arrange for enough supplies, food etc.

Registration Notification is also helpful for planning by letting us know that you will be attending. No payment is

required for notification, however you are NOT guaranteed sleeping arrangements. Please call 1-225-761-4709 or

email larbsc@yahoo.com for notification. Thank you in advance for your assistance.



I/We will be attending the Louisiana Spring Bahá’í School. *For children, junior youth & youth, please include age.



Adult, Child or Arriving

Name youth (age) *

Gender Address Telephone

Thu/Fri/Sat









Special Dietary (Vegetarian, diabetic, etc...) or other Needs: _________________________________________



I/We would like to volunteer in the following areas (Please circle):

* Children’s Classes *Kitchen *Clean-up *Devotions *Security *Other____________________



BAHÁ’Í SCHOOL STANDARDS



To preserve and enhance group unity and respect the standards of our Faith, the Bahá’í School Committee has adopted standards for all of us

while at school. Each of these standards is designed to protect the Faith, the school, and the participants. They are fully obligatory for all

attendees. Parents/Sponsors should make sure that children and youth understand the standards.



A. Class attendance is required for all ages

B. Please do not bring pets, tape or CD players, "walkmen", radios, TVs or computer games to Bahá’í School.

C. Each child/youth under age 18 who attends the school without a parent must be accompanied by a sponsor who will be responsible for the

child's welfare and conduct. Sponsors should be 21 or older, considerably more mature than and of the some sex as those sponsored. The only

exception is that a Grandparent, aunt or uncle may sponsor a related child of either sex. No adult should sponsor more than two children in

addition to his/her own. Sponsor and child must be housed together during the school.

D. Parents and sponsors of all children as well as youth are completely responsible for their charges at all times when students are not in

class. This includes meal times, free times, and evenings.

E. Accidents or illness should be reported to the First Aid Staff or School Director. Medical releases for minors (18 and under) are necessary,

even if parents are on campus.

F. Visitors and day students should check in at Registration.

G. No smoking will be allowed in classrooms or near dormitories.

H. A curfew of 9:30 p.m. is suggested for those ages 11 and under. Quiet Hours begin at 11:00 p.m. for all ages.

I. Camp facilities should be kept clean and in good order.

J. No drugs or alcohol will be tolerated.

K. No firearms or martial arts items will be permitted.

L. We will adhere strictly to the code of conduct and dress as prescribed by Shoghi Effendi. High standards of morality, courtesy, cleanliness

and modesty of dress will be upheld.

M. Disobedience of these rules may result in dismissal from the school.

N. Questions on school standards may be referred to the Regional School Committee.

Louisiana Regional Bahá'í School:

November 11-14, 2004



Registration begins at noon on Thursday, November 11th and school will end at noon on Sunday,

November 14th.

Keynote speaker: Jack Guillebeaux

Musical Guests: Carla Baker-Braithwaite and Oraea Varis

Workshops : The role of the people of Baha in the Unfoldment of World Civilization by Jack Guillebeaux

The Revelation of Bahá'u'lláh and the Evolution of Human Society by Carla and Dr. Sylvester Braithwaite

The Characteristics of the Age of Transition; Precursor to the Era of Blissful Felicity by Jeanette Hedayati

Introduction to Islam & Quran by Dr. Sohrab Kourosh

Youth and Children’s activities and classes

Fun and Learning for All

Jimmie Davis State Park is situated on a peninsula which extends into Caney Lake. The landscape is a

beautiful mixed pine and hardwood forest surrounding the lake which the birds and animals make their

home.

Housing: The 4 dorms have 36 semi-private rooms which have 2 bunk beds per room. Each dorm has a

single male and single female bathroom facility. The dorm room will allow a family of 4 to 6 people to stay

together. If you want to sleep more than 4 people per dorm room you can bring air mattress, sleeping

bag, or cot. You must bring your own sleeping bag or sheets for single beds and a pillows. Look at the

school’s dorms by visiting: http://www.lastateparks.com/jimmiedavis/jimmiedavis.htm. Tent &

camper sites also available, cost not included in school fee. Please call the park at 1-888-677-2263 to

reserve. There is a camping supply store and laundry.



What to Bring: Towels, Wash cloths, Robe, Soap, Shampoo, Flashlight, Binoculars, Board Games, and

Mosquito repellent. Bring lawn or folding chairs for Friday’s picnic. Please do not bring pets, tape or CD

players, "walkman", radios, TVs or computer games to Bahá’í School. (See Bahá’í School Standards).



Private Cabins: This year the school has made special reservations of 8 private cabins which will rent for

$110.00 for the weekend (½ off regular price). The cabins will be assigned at a first pay first reserved

basis. The cabin fee does not include the registration fee. Payment must be received by October 25, 2004

to reserve a cabin. There will be no on-site registration of cabins. The cabins can sleep 8 people (1

double, 2 bunks, 1 queen sofa bed). Cabins are the responsibility of the person renting the cabin. The

cabins are located about 1 miles from the main hall.

Meals: On-site volunteer cooks will lovingly prepare all meals, so if you have special dietary needs, please

let us know. Vegetarian options will be available at all meals.

Cost/Fees: This fee covers administrative costs and meals for entire weekend. Service scholarships are

available upon request. Contact us by email larbsc@yahoo.com or by calling 1-225-761-4709 for more

registration information.

$65 per adult (ages 21-64) · $55 for Senior Discount (ages 65-75) · $50 for youth (ages 15-20)

$25 for children (ages 5-14) · $155 for a family · FREE for anyone under 4 or over 75

Please Keep this Sheet for your Information

If lost or need directions contact the park at 888-677-2263 until 9pm, after 9pm call (504) 451-3689

Directions: You can obtain directions from Map Quest (www.mapquest.com) by using 2200 Lakeshore Dr. Chatham, LA 71226 as

destination address.

From SE LA/New Orleans –Take I-10 W to Lafayette and follow SW LA / Lafayette’s directions.

From SW LA /Lafayette – Take I-49 N to Alexandria (84mi). Take US-167N (exit # 84) to Jonesboro (71mi). Turn RIGHT onto LA-4 (15mi). Turn

RIGHT onto LAKESHORE DR. (3hr. 40min)

From NW LA/Shreveport – Take I-20 E towards Ruston. Take the US-167 exit- exit #85- toward RUSTON/DUBACH. Turn RIGHT onto US-167

S/LA-146 S/N TRENTON ST. take US-167 S. to Jonesboro (22mi) turn LEFT at LA-4 go 15mi. Turn RIGHT onto LAKESHORE DR/PR 486. (2hr. 9mins)

Once on LAKESHORE DR. Turn onto STATE PARK RD. Make the first RIGHT after entering the park to get to GROUP CAMP

Follow the brown state parks signs.

Louisiana Bahá'í

Fall School



Unfoldment of

World

Civilization









November 11-14, 2004

Jimmie Davis State Park • Chatham, LA



Including Special Birth of Bahá’u’lláh Celebration



Keynote speaker: Jack Guillebeaux, Southern Regional Council

Musical Guests: Carla Baker-Braithwaite and Oraea Varis

Workshops by Jack Guillebeaux, Carla and Dr. Sylvester Braithwaite

and Jeanette Hedayati

Introduction to Islam and the Quran by Dr. Sohrab Kourosh


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