Immovable Registration

Camper's Name*

First Last

Age*

T-Shirt Size*

Grade Completed*

Address*

Street Address Address Line 2 City State ZIP Code

Home Congregation*

Home Congregation City and ST*

Name of Parent/Guardian*

First Last

Parent's Email*

Home Phone

Work Phone

Cell Phone

Family Doctor Name

First Last

Family Doctor Phone

Do you have any allergies?*

Yes
No

What are they?

Do you have any chronic illnesses?*

Yes
No

Please describe:

Are you bringing any special medication?*

Yes
No

Please list them here:

Parental Consent for Medical Needs (Part 1)*

I/we herby give permission for the directors and camp nurse to take the registered child to the hospital or to a doctor in case of accident or sickness and/or to receive medical treatment as prescribed by an attending physician. I/We understand that Immovable Christian Girls Camp will not be held liable for this camper and I/we will never bring legal action against Immovable Christian Girls Camp.  

Parental Consent for Medical Needs (Part 2)*

I/We give permission for the registered child to take short road trips for hiking trips and/or service projects in nearby Cleburne and the Cleburne State Park as the Directors schedules allow, as well as participate in hiking, tractor rides and exploring 250 acre farm with supervision. In case of accident, I/we give authority and consent for medical and surgical treatment as needed in the judgment of treating physicians. I/we also agree that Immovable Christian Girls Camp, its staff members and the owners of the farm will not be held liable in case of accident. I/We will never bring legal action against Immovable Christian Girls Camp.,

Parent/Guardian's Signature*