Camp Palestine 2001 Participation Form
Participant's Name: ________________________________________ Age: _____
Male: Female: Circle -Shirt Size: Youth: S M L - Adult: S M L XL
Email address: _______________________________________________________
Parent/Guardian Name: ________________________________________________
Address:
____________________________________________________________
City:______________________
State:_______________ Zip_______________
Phone Numbers: _____________________________________________________
Emergency Contact Person: ___________________________________________
Phone Number: ______________________________________________________
Does
the participant have any allergies?
Yes
No
If
yes, please list allergies: _____________________________________________
____________________________________________________________________
Other
medical conditions we should be aware of: ___________________________
____________________________________________________________________
Participant's
Agreement
As
a participant of Camp Palestine, I agree to follow the rules set by the Camp
Palestine Committee.
I will be kind to other people and respect authority.
I understand that I am responsible for my safety and that neither the
Camp Committee nor the ACC are liable for any injuries.
I promise to have safe fun!
Participant's
Signature: ____________________________________
Date:_____________
Parent/Guardian
Signature:
________________________________
Date:_____________
Palestine Affairs Council