Medical Release

I give permission for ________________ to

travel to Canada with Harbor Covenant Church
(Gig Harbor, WA) July 7-16, 2009.
I hereby release Harbor Covenant Church, its
staff and sponsors, from responsibility and lia-
bility 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 This side you fill out and turn in.

YWAM Vancouver Mission Trip

as advised by a physician, surgeon or dentist
(as appropriate) as listened to practice under
the laws of the state/province where the ser- This side you keep so you have the info!
vices are rendered, either at the doctor’s 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 in-
jury 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 clarification call Blake).

_____________________ _______
Parent or Legal Guardian Date

Harbor Covenant Church,

5601 Gustafson Dr. NW
Gig Harbor, WA 98335
(253) 851-8450
 What you need to know
When: July 7 - 16
Times: Leave HCC 10am, Tuesday, July 7.
Return to HCC 8pm Friday, July 16.
Passport Info:
You need a passport! It may take up to 8 weeks
to get a passport and passports are mandatory
for the trip, no exceptions. So please take take
care of this immediately. (note: the city of Gig Har-
bor no longer offers passport services)
Cost:
$1,000 (includes both summer camp and Vancou-
ver mission trip). Payments can be mailed to the
church or placed in the drop box outside the youth
pod in the ed. building.
Please check our optional payment plan for a
suggested schedule.
Your $100 non-refundable deposit gets you on
the sign up list and it is due by 11/30/08.
Fundraisers:
Fundraising will take care of a significant portion
of this cost, however, this necessitates students
participating in the opportunities presented.
More Information
Last summer 16 of us ventured to Vancouver,
British Columbia not really knowing what to ex-
pect. For all of us, adults included, to say this trip
was life-changing would be an understatement.
We experienced God in ways many of us had
never experienced before. We saw God in plac-
es we have never seen before. As a group, our
bonds were knitted together as we followed Je-
sus with an intensity that was exciting and in-
spiring.
On this trip you will be exposed to cultures,
foods, people, poverty, and experiences that
will be transforming. You will hear God’s voice
in your life in a fresh way as you learn to place
deeper trust in God. You will love God and oth-
ers more!
You will grow deep relationships with your team,
which for many, will last years and years. But
not only will you develop relationships with your
team, but you will make new friends with the
YWAM staff and the people we are serving.
We thought this trip was so important, so im-
pactful, so amazing, we knew we needed to do it
again this summer. But we aren’t content with 16
people going, everyone needs this experience.
You need this experience!
Registration
Name________________________________
Age _______ Grade _________ Gender____
Shirt Size (please circle one): S M L XL
Address ______________________________
City ____________________ Zip __________
Parents’ Names ________________________
Phone # ______________
Alternate Contact _______________________
Relation ______________________________
Phone # ____________ Work # ___________
MEDICAL INFORMATION:
Allergies: _____________________________
Medication Being Taken: _________________
_____________________________________
_____________________________________
Physical Handicaps or Limitations: __________
_____________________________________
_____________________________________
Medical Insurance Company: ______________
_____________________________________
Policy Number: ________________________
Member’s Name: ______________________
Primary Physician: _____________________
Physician’s Phone# ____________________
cont. on back...