| 2008 Summer Youth Camp |
“…I urge you to live a life worthy of the calling you have received. Be completely humble
and gentle; be patient, bearing with one another in love. Make every effort to keep the unity of the
Spirit through the bond of peace.” ~Ephesians 4:1-3
Dates : August 3-8, 2008
Speakers: Christopher Yuan, Marcus Given, Curtis Chinn, TBA *Different speaker each night
Location: Alliance Redwoods Conference Campgrounds
6250 Bohemian Highway, Occidental, CA
**DO NOT send registration forms or checks to this address**
Ages: All students who have completed 6th through 12th grades
Rates: $315 (by June 1st), $335 (by July 9th), $365 (after July 9th)
How to Register: Deliver the following items to your church camp coordinator --
1. Completed registration form
2. Medical and liability release form (with both sides completed and signed)
3. Check made payable to YOUR CHURCH
**50% refunds will be given only for medical reasons with a doctor’s letter**
Note to individual students: If your church is NOT coming, make a check out to BAAYF and send it with the registration form
to the address below.
Note to church coordinators: Please send ONE CHURCH CHECK made payable to BAAYF with all collected forms to:
Carrie Chan, 1805 Branbury Court, Petaluma, CA 94954
Registration Form 2008 BAAYF Summer Youth Camp
Name: _____________________________________Phone #____________________
City: __________________________________ State: ________ Zip: _________
Age: _________ Gender: (circle) M F Last grade completed: ________
Home church: _________________________________________
City/State: _______________________ T-shirt size: (circle) XS S M L XL
For office use only (please do not write in this box)
Check #: _________ Cabin ______________________ Counselor:
Camp Site: _Alliance Redwoods Conference Grounds
Starting Date: Aug 3th, 2008 Ending Date: Aug 8th, 2008
Please complete both sides of this document and sign the areas indicated on the back of this form in ink.
Name of minor:______________________________________ Phone: ( )_______________
Soc. Sec. No. :______-_____-______ Age:_____ Weight:_______ Date of Birth:____/____/____
Address:_______________________________________ City:_______________ Zip:________
Church Affiliation:____________________________________ Pastor:______________________
Emergency contact: _________________________________ Relationship: _________________
Address: ________________________________ City:___________ Phone: ( )_____________
Family Doctor: _______________________________________ Phone: ( )_______________
Address: ______________________________________ City: _______________ Zip: _________
Insurance Co.: ______________________________________ Phone: ( )________________
Address: _______________________________City: _____________ State: _____ Zip: ________
Insured Person: __________________ Soc. Sec. No.: _____-____-_____ Relationship:___________
Date of Birth: _____/_____/_____ Occupation _________________________________________
Full or Part-time Policy #:_____________________ Policy Group Name:______________________
Employer: _______________________________________ Phone: ( )___________________
Address: _____________________________________ City: ________________Zip: _________
Drugs: _______________________ Foods: ______________________ Insects: _______________
Other Pertinent Information:_________________________________________________________
Last Tetanus Shot: ____/____/____
Check all that apply: Diabetes____ Heart Condition____ Asthma____ Epilepsy____ Headaches____
Last or Current Injury/Illness and Medications:
Over-the-Counter and/or Prescription medications to Avoid:
Restrictions/precautions to take:
[side 1: complete and sign other (liability) side also]
Medical and Liability Release
Please be sure to read and understand this document , and then sign and date both areas indicated at the bottom of this page.
I agree to allow the Alliance Redwoods Conference Grounds/BAAYF Health Care Staff to render care to, arrange transportation for and administer over-
the-counter medications to, the named minor, within the Staff scope of practice, and as deemed beneficial to the health and well-being of the named minor.
I further agree that all over-the-counter and prescription medications brought to camp will be collected by and then only administered by the Alliance
Redwoods Conference Grounds/BAAYF Health Care Staff, in accordance with all applicable prescriptive directions and/or on an as needed basis. No
medications having reached an expiration date will be accepted or administered.
In the event I cannot be reached by phone at the time of an injury or illness to the named minor, I hereby give, as parent/legal guardian, my permission to
the doctor selected by Alliance Redwoods Conference Grounds/BAAYF to hospitalize, access and procure necessary medical records, and secure
appropriate treatment, including but not limited to injections, anesthesia, testing, radiology, or surgery for the named minor as deemed necessary. Medical
insurance coverage by the Alliance Redwoods Conference Grounds/BAAYF insurer is secondary to your medical insurance policy, and is available only
following the usage of your policy to the limit of your policy coverage or if you have no medical insurance of your own. As the parent/legal guardian, in
the event the bill exceeds BAAYF insurance coverage, I __________________________ (signature), assume financial responsibility. As the parent/legal
guardian, if I chose to forego additional medical treatment I am responsible for bringing my camper home.
I understand that in signing this form that I am providing both a Medical and Liability Release to the Alliance Redwoods Conference Grounds/BAAYF for
the minor named on the front page. I hereby acknowledge that during his/her attendance at a camp session certain risks exist, which may be known or
unknown at this time, and may result in physical injury or illness. In signing this Liability Release, I assume full responsibility for mitigation of such an
incident, and I am granting permission for the participation of the named minor in all session related activities, unless specifically noted on this form.
Should the named minor elect to participate in an activity off of the grounds of Alliance Redwoods Conference Grounds/BAAYF, it is understood and
agreed that transportation, to and from the activity shall be the responsibility of individuals as designated by the parent/legal guardian. This release is
intended to stand on the behalf of the named minor, and in place of all claims by any family member or agent. These releases of Alliance Redwoods
Conference Grounds/BAAYF shall be in effect only for the duration of the camp session as indicated and only while the named minor is on the grounds of
Alliance Redwoods Conference Grounds/BAAYF, and/or under the directed supervision of Alliance Redwoods Conference Grounds/BAAYF employees.
I agree that, in the event of dispute between myself as guest or parent/legal guardian of, or on behalf of, the named minor, I will submit to arbitration by an
organization sanctioned for this purpose, in lieu of pursuing litigation in a court of law. I further agree as parent/legal guardian, to absolve and hold
harmless the Alliance Redwoods Conference Grounds/BAAYF, a non-profit corporation, its board of Directors and Trustees, agents and employees,
against liability for damages, losses, or injuries or illnesses to, myself, my property, or the named minor.
Non-compliance with disclosed behavioral standards and instructions, written or oral, may result in disciplinary actions, up to and including, being asked
to remove the named minor from the grounds. Anyone asked to leave the grounds shall forfeit all camp fees previously paid, while remaining liable for
any fees due.
I hereby give my permission to the Alliance Redwoods Conference Grounds/BAAYF to use photography of the named minor taken while on the grounds
for promotional purposes.
Parent /Legal Guardian signature: __________________________________________Date: ____________
Name of Minor: _______________________________________________________________________
Please check one of the following options and sign below:
____ I will be transporting the named minor to and from Alliance Redwoods Conference Grounds.
____ The following person or organization has my permission to receive and transport the named minor from the care and facilities of the Alliance
Redwoods Conference Grounds/BAAYF at the conclusion of the camp session as indicated.
Please fill in name of approved person/organization: _______________________________________________________
Parent /Legal Guardian signature: ____________________________________________ Date: ____________
Name of Minor: _______________________________________________________________________
[side 2: complete and sign other (medical) side also]