Enjoy a day of farm life & discovering the good news of the gospel. 
 
Kids will be provided with:  LUNCH; SNACKS; & a BACKPACK.
 
Be sure to bring the following:
1)BUG SPRAY  2) SUNSCREEN  3)WATER BOTTLE  4)HAT  5)CLOSE-TOED SHOES
 
Bus rides will be available! 
Please MEET at GVBC at 9:00AM for DROP-OFF and 5:30PM for PICK-UP
 
Please pick up a registration form from the Children’s Check-In Desk
or fill out the form below.
 
To Register for this event, please fill out the following Registration/Medical Release/Transportation Form:
 

GVBC Day Camp 2018





Child’s Name (required)

Male or Female? (required)

MaleFemale

Age of Child?

Grade?

Child’s Birthdate(required)

Parent’s Name (or Legal Guardian) (required)

Street address (required)

Your city (required)

Your state (required)

Your zip (required)

Cell Phone 1 (required)

Cell Phone 2 (required)

Email (required)

Insurance Company Name (required)

Policy Number (required)

Primary Doctor (required)

Emergency Contact (required)

Emergency Phone (required)

Relationship to Child (required)

Please list special needs or allergies:

Please list medications, including dosage instructions:

Medical release: See below. (required)
Yes, I have read and agree to the GVBC Medical Release.No, I have read and do not agree.

Permission to ride the bus?(required)
YesNo

Child’s Name to be transported

Has permission to ride the bus TO GVBC Daycamp on 6/30/18?
YesNo

Has permission to ride the bus FROM GVBC Daycamp on 6/30/18?
YesNo

Contact Name of Person picking up the child.

Contact Number of Person picking up the child.

Parent Authorization
Yes, I authorize GVBC to transport my child.No, I do not authorize GVBC to transport my child.

GVBC Medical Release:
In case of emergency, I understand that every effort will be made to contact the above named parent(s) or guardian(s).  In the event that they can not be reached or give verbal consent, I, as parent or guardian do hereby grant permission for a qualified physician to give emergency medical treatment to my child.
 
I also hereby give permission to Green Valley Volunteers and representatives to provide routine health care and administer necessary medications.
 
I understand that Green Valley Volunteers and representatives will do everything in their power to responsibly oversee participants.  I will in no way hold the directors or volunteers responsible for any accidents or illness that might occur to the participant during his/her stay at day camp.