Beruflich Dokumente
Kultur Dokumente
WORSHIP GOD!
WHERE:
CAMP WANAKE
Beach City, Ohio
COST:
$25
WHAT TO BRING!
Sleeping bag
Pillow
Weather Appropriate Clothes
Comfortable shoes/boots
Snacks
Emergency Contacts:
1. Name:__________________________ Relationship to participant__________________
Day Phone: __________________ Night Phone: ______________________
2. Name:__________________________ Relationship to participant__________________
Day Phone: __________________ Night phone: ______________________
Medical/Health Information: Allergies, chronic illness, or other pertinent health history: ________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Current Medications to be taken during the event which will be kept by the leaders:
_____________________________________________________________________________
_______________________________________________________
Any other Information (special needs, concerns):
_____________________________________________________________________________
_____________________________________________________________________________
____________________________________________
Doctor: ______________________________Phone:________________________
Insurance ID# ______________________________Name on insurance card: _______________________
I give permission to the leaders of FUMC Youth to authorize emergency medical procedures for
my child. They may also transport my child to and from _______________________(hospital).
Parent/Guardian signature: _______________________________
EMERGENCY MEDICAL AUTHORIZAION
I give my consent for emergency medical treatment by a certified first aider. In the event that additional
treatment is needed, the staff of the Emergency room of the hospital listed above, or one closest to the event
location, has my permission.
Parent/Guardian Signature________________________________Date:___________________________
Address__________________________________________________________________________
Phone (home) _________________________Work (work) ____________________________
Hospitalization plan and Group No.:___________________________________________________________