I give permission for ___________________________________________________ age ___________,
to participate in Summit Christian School's Summer Camp Program from June 9 - August 1, 2008.

I also give my permission for my child to be treated by a physician, chosen by and adult leader with the Camp Program, in case of accident or serious illness, in the event that I cannot be reached.

I agree to hold Summit Christian School, its staff and officers, free from any liability for property damage or bodily harm.

I further agree that our personal insurance coverage will be the primary insurance carrier in the event of an accidental injury.

Insurance Carrier___________________________________________ Policy # ________________________________

Students will not receive any medication unless provided by the parent
with written permission and specific instructions.

Allergies:_________________________________________________________________________________________

Special Instructions:_________________________________________________________________________________

Family Physician: ______________________________________________Phone:______________________________

I HAVE READ AND AGREE TO THE DISCIPLINARY PROCEDURES, FILED TRIP PARTICIPATION, MEDICAL AUTHORIZATION AND MEDICAL RELEASE FORM.

Date:_________________ Parent or Legal Guardian:______________________________________________________

Notary:_________________________________________________________________________Date:_____________

Notary Seal (below)