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What you need to know:

We’re Back!!! That’s right Camp Spalding, When Does Registration close? May 31st
the Westside is coming! Who? For incoming 6th to incoming 8th grade students!
We will be headed out to Camp Spalding, When? Aug. 9-15th 2009
located North of Spokane WA. There are tons Why? Because it is one of the best ways to meet fellow
students in the youth group, meet the Middle School Staff
to do! team, and bring a friend!
We will be swimming, boating, mountain What should I bring? Sleeping bag, Money (for two
biking, Bible Studying, Rock Wall Climbing, meals on the road and the snack bar), Bible, a light jacket,
Disc Golfing, Mountain Boarding, Cliff toiletries, swimsuit (one piece only), towel, journal, pen,
Repelling, as well as having opportunities to friends, camera, pillow, flashlight.
do crafts, watch skits and just taking time to What shouldn’t I bring? Personal electronic devices
rest around God’s amazing handiwork! They (anti-social), weapons, drugs, alcohol, pets, expensive
even have horses and lots plenty of lakeside personal items, or Ping Pong Tables.
activities (like the zip line over the lake!). How much is it? $395. And like always, scholarships
are available! You can pick up a form in room 106 or
Join us in what will prove to be an awesome online at www.hccfuel.com. If you have any questions,
week! please call Jen Easton!
Sign up fast because this year, spots are How do I sign up? Complete and detach the registration
extremely limited! As soon as we are filled form, attach payment ($50 non-refundable deposit) and
we will add you to a waiting list and will do then place in the lock box outside the youth pod
(room 106). Complete payment is due by July 16th.
our best to get you there!
When should I sign up: Now!
If you have any questions, please contact Jen Applications will be accepted in the order they received
Easton at 253.851.8450 or email him at and spots are extremely limited this year!
jeaston@harborcovenant.org!
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Please Detach Here Please Detach Here Please Detach Here

Medical Release Form


I give permission for ______________________ to travel to “Camp Spalding” with Harbor Covenant Church (Gig Harbor,
WA) Aug. 9-15th, 2009.
I hereby release Harbor Covenant Church, its staff and sponsors, from responsibility and liability for any injury and illness that
my child may sustain during this activity. In the event of an emergency, I hereby authorize an adult leader of this activity, as an agent
for me, to consent to any x-ray examination; medical, dental or surgical diagnosis; treatment; and hospital care as advised by a physi-
cian, surgeon or dentist (as appropriate) as listened to practice under the laws of the state/province where the services are rendered, ei-
ther at the doctors office or in any hospital. I expect to be contacted as soon as possible.
I also understand that if my child is disruptive, brings alcohol, drugs, weapons, causes any injury to themselves or others, or
engages in any unacceptable behavior, I will be responsible to remove my child from this activity and transport them immediately back
to Gig Harbor.
_____________________ ___________
Parent or Legal Guardian Date

Photography Release
The undersigned gives permission to Harbor Covenant Church to photograph his or her son or daughter and use the resulting
photographs for any purpose that Harbor Covenant Church deems proper. (For further explanation, please contact Jen Easton at the
church (253-851-8450—jeaston@harborcovenant.org or his cell 253-241-3760).
_____________________ ___________ Please fill out both sides of this
Parent or Legal Guardian Date page! Thanks!

Harbor Covenant Church, 5601 Gustafson Dr. NW Gig Harbor, WA 98335 — 253.851.8450

*Both sides of this form will need to be filled and checks will need to be made out to
“Harbor Covenant Church” with “Camp Spalding—<student’s name>” in the memo line—Thanks!
CAMP SPALDING REGISTRATION AND MEDICAL RELEASE
HEALTH INFORMATION Yes No Registration
Appendictis .................................................................. O O
Name______________________
Asthma ......................................................................... O O
Convulsions................................................................... O O Age ____ Grade (In Fall)____ Gender ____
Diabetes ........................................................................ O O Shirt Size: S M L XL
Digestive problems........................................................ O O
Address __________________________________
Ear trouble...................................................................... O O
Emotional problems ...................................................... O O City ______________________Zip ____________
Epilepsy......................................................................... O O Parent’s Names ____________________________
Heart trouble ................................................................. O O
Phone # _________________________________
Hernia ............................................................................ O O
Lung problem ................................................................ O O E-mail Address____________________________
Menstrual problem ........................................................ O O Alternate Contact __________________________
Skin problem ................................................................. O O
Phone # _____________ Work # _____________
Known allergy to:
Penicillin..........................................................O O MEDICAL INFORMATION:
Insect Stings.....................................................O O Allergies: _________________________________
Food(s)............................................................O O
Medication Being Taken: _____________________
Other drugs......................................................O O
Type __________________________________ __________________________________________
Surgery within last 2 years? ............................................O O Physical Handicaps or Limitations: _____________
Type__________________________________________
__________________________________________
Last Tetanus shot _______________________________
Swimmer? ........................................................................O O Medical Insurance Company: _________________
Camper restrictions: Policy Number: ____________________________
Member’s Name: ___________________________
In case of emergency, I give my authorization to provide whatever
emergency care is necessary for my child’s safety, and assume Primary Physician: __________________________
primary responsibility for payment. Physician’s Phone# _________________________
______________ _________ Please fill out both sides of
Parent Signature Date this page! Thanks!
Please Detach Here Please Detach Here Please Detach Here
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Aug. 9-15th

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