CAMPBRIARWOOD2017 REGISTRATION FORM - … · $365 2 1st–3rd Mon–Fri June 26–30 Session...

2
CAMPBRIARWOOD2017 REGISTRATION FORM PLEASE CONTINUE ON REVERSE ________________________________________________________ Last Name First Name child goes by ________________________________________________________ Date of Birth Age Sex Grade (Entering in Fall) ________________________________________________________ Child’s Address ________________________________________________________ City State Zip ________________________________________________________ Father/Guardian’s Name Cell Phone # ________________________________________________________ Mother/Guardian’s Name Cell Phone # ________________________________________________________ Primary Email Address Home Phone # ________________________________________________________ Emergency Contact Name Phone # ________________________________________________________ Physician’s Name Phone # PLEASE FILL OUT COMPLETELY To secure a spot for camp, please complete a separate card for each child and send with a non-refundable deposit of: $50 (Day Camp) or $100 (Overnight Camp), and mail to: Camp Briarwood, 2200 Briarwood Way, Birmingham, AL 35243 CAMP SESSION (Please circle one): Day Camp: 1 2 Please register me for After-Camp Care for an additional $40/week ( ) Overnight: A B C D Special Connections: Day Camp Overnight Camp If your child is attending as a special needs camper, please contact June Cork, Director, Special Connections at 776-5291. I WOULD LIKE TO ORDER THE FOLLOWING: ( ) Camp T-Shirt–$15 ( ) Camp Group Photo–$8 Quantity___________ Quantity___________ T-Shirt Size (Please circle one): Y-S Y-M Y-L A-S A-M A-L A-XL CHOICE OF ROOMMATE OR GROUPMATE: _______________________________________________ First Choice Second Choice _______________________________________________ Full Name of Church Now Attending For Office Use Only Cut Here

Transcript of CAMPBRIARWOOD2017 REGISTRATION FORM - … · $365 2 1st–3rd Mon–Fri June 26–30 Session...

Registration closes for each session when it fills up. C

ampers’ registrations received after a session is full

will be put on a w

aiting list. Popular sessions often fill up in the first 3 weeks after registration begins.

TO SEC

UR

E A SPO

T, we m

ust receive: • A

registration card with both sides com

pleted, for each camper.

• A non-refundable deposit for each cam

per: Day C

amp – $50, O

vernight Cam

p – $100• Sorry, w

e can’t take credit or debit cards.

TO K

EEP YOU

R SPO

T, we m

ust receive the balance of your camp fee by June 5. O

n June 6 w

e may fill the spots of unpaid cam

pers with those on the w

aiting lists.

Some scholarships m

ay be available and are awarded based on need. Please contact the

camp office for an application. Scholarship applications are due A

pril 29.

Cam

p Briarwood does not discrim

inate on the basis of any race, color, national or ethnic origin, or religion in adm

inistration of its policies or admission.

WH

AT TO W

EAR

/BRIN

G TO

CA

MP: (Please label everything)

Day C

amp: Shorts, t-shirt, socks, closed-toe shoes (lace-up or Velcro), sw

imsuit &

towel

in w

aterproof bag

(each day

of cam

p). Thurs.

Overnight:

Sleeping bag,

pillow,

toothbrush, toothpaste, and pajamas. **N

o sports or fishing gear needed.

Overnight

Cam

p: long

pants (for

hiking and

horseback riding),

shorts, shirts,

swim

suit (no

bikinis), 2

pair shoes

(one pair

of closed-toe

shoes), jacket,

pajamas,

underwear (for each day), robe, tow

els (bath & beach), blanket, 2 sheets O

R sleeping bag,

pillow, w

ashcloth, toothbrush, toothpaste, flashlight, comb, soap, Bible, notebook, pencil,

stamps, stationery, and hair dryer. O

PTION

AL: battery operated fan

RECR

EATIO

NO

UT

REACH

If you have any questions, please call the camp office at 776-5237. Registration m

ay be dropped off at Briarw

ood Presbyterian Church in the C

amp O

ffice (G-100) or

mailed to: C

amp Briarw

ood, 2200 Briarwood W

ay, Birmingham

, Alabam

a, 35243.

For more inform

ation, check our website at C

ampB

riarwood.org.

SessionEntering G

radesD

ays of W

eekD

atesC

ost

11st–3rd

Mon–Fri

June 12–16$365

21st–3rd

Mon–Fri

June 26–30

$365

SessionEntering G

radesD

ays of W

eekD

atesC

ost

A4th–6th

Mon–Sat

June 26–July 1

$535

B3rd–4th

Weds–Sat

July 5–8

$435

C5th–7th

Mon–Sat

July 10–15

$535

D7th–10

thM

on–SatJuly 17–22

$535

DAY

CA

MP:

OV

ERN

IGH

T CA

MP:

LOC

ATION

: Day C

amp is held at Y

MC

A C

amp H

argis, located approximately 15 m

iles from

Briarwood Presbyterian C

hurch. Cam

p will be held from

8:30 a.m until 3:15 p.m

. each day. Lunch is provided each day at H

argis.

AC

TIVITIES: Each session includes hiking, sw

imm

ing, arts and crafts, canoeing, B.B. guns and archery. Bible stories and songs help children grow

in their relationships with each

other and with G

od. Lunches and snacks are provided each day.

CO

UN

SELOR

S: A ratio of approxim

ately 6 campers to each counselor ensures that each

child will receive personal attention. C

ounselors receive training in all aspects of camp.

CH

ECK

-IN: Each session runs from

Monday through Friday. C

ampers and a guardian

should arrive at Briarwood’s church Fellow

ship Hall on M

onday at 8:00 a.m. for check-in

and information. Tuesday–Friday cam

pers should arrive at 8:30 a.m.

CH

ECK

-OU

T: Each day at 3:15 p.m. from

the Briarwood Presbyterian C

hurch gym.

Anyone picking up a cam

per must be approved by the cam

per’s guardian in writing, and

be ready to show a current driver’s license.

THU

RSD

AY SPEN

D-TH

E-NIG

HT: Som

e sessions offer the option to spend the night on Thursday. These w

ill be held at Briarwood C

hurch and will include a night full of

activities, games, m

ovies, music, w

orship and more–even som

e sleep! A pizza party

supper Thursday night and Friday morning breakfast of juice, m

ilk, cereal and pastries are included. C

ampers should bring sleeping bag, tooth brush, pillow

, etc.

PAR

ENTS M

EETING

: A Parents M

eeting will be held Tuesday, June 6 from

5:30–6:30 p.m.

in the Chapel at Briarw

ood Presbyterian Church.

Special Connections C

amp is a C

hristian camp for boys and girls w

ith mild to m

oderate disabilities. C

amp Briarw

ood partners with the Special C

onnections ministry, a com

munity

outreach to families touched by disability. For m

ore info, call 776-5291.

AC

TIVITIES: Each special cam

per participates with typically-developing cam

pers in the full range of cam

p activities.

CO

UN

SELOR

S: Each camper is assigned his/her ow

n counselor for the week. The

counselors are able to attend to the campers’ needs and provide support in order for the

camper to participate w

ith a typical camp group. C

ounselors are trained to understand specific disabilities of the cam

pers. Strong emphasis is placed on cam

per safety and each counselor is trained in safety techniques.

DETA

ILS: There are Day C

amp and O

vernight Cam

p sessions available for special needs cam

pers during select weeks. The cam

p rates, schedule, check-in/check-out procedures, activities and attire are the sam

e for campers w

ith disabilities as for campers w

ithout disabilities. Please refer to the other pages of this brochure for this inform

ation.

REG

ISTRATIO

N PR

OC

ESS: Upon receipt of your registration form

and deposit, Special C

onnections staff will contact you to discuss your cam

per’s specific needs, which sessions

are available and to answer your questions. C

onfirmation of your cam

per’s placement in a

session will only be m

ade after contact with the Special C

onnections staff.

CAMPBRIARWOOD2017 REGISTRATION FORM

PLEASE CONTINUE ON REVERSE

________________________________________________________ Last Name First Name child goes by

________________________________________________________ Date of Birth Age Sex Grade (Entering in Fall)

________________________________________________________ Child’s Address

________________________________________________________ City State Zip

________________________________________________________ Father/Guardian’s Name Cell Phone #

________________________________________________________ Mother/Guardian’s Name Cell Phone #

________________________________________________________ Primary Email Address Home Phone #

________________________________________________________ Emergency Contact Name Phone #

________________________________________________________ Physician’s Name Phone #

PLEASE FILL OUT COMPLETELYTo secure a spot for camp, please complete a separate card for each child and send with a non-refundable deposit of:

$50 (Day Camp) or $100 (Overnight Camp), and mail to: Camp Briarwood, 2200 Briarwood Way, Birmingham, AL 35243

CAMP SESSION (Please circle one):

Day Camp: 1 2 Please register me for After-Camp Care for an additional $40/week ( )

Overnight: A B C D Special Connections: Day Camp Overnight CampIf your child is attending as a special needs camper, please contact June Cork, Director, Special Connections at 776-5291.

I WOULD LIKE TO ORDER THE FOLLOWING:

( ) Camp T-Shirt–$15 ( ) Camp Group Photo–$8Quantity___________ Quantity___________T-Shirt Size (Please circle one):Y-S Y-M Y-L A-S A-M A-L A-XL

CHOICE OF ROOMMATE OR GROUPMATE:_______________________________________________First Choice Second Choice _______________________________________________Full Name of Church Now Attending

For Office U

se Only

Cut Here

LOC

ATION

: Overnight C

amp is held at Y

MC

A C

amp C

handler, located on Lake Jordan near W

etumpka, A

L. Covering 475 acres, C

amp C

handler is the perfect setting for a week

of fun and growth.

AC

TIVITIES: O

vernight Cam

p offers activities such as canoeing, sailing, skiing, riflery, archery, arts and crafts, horseback riding, and a high ropes course that thrills every participant. C

ertain activities are available for specific age groups.

CH

ECK

-IN: Each cam

per and a guardian should arrive at Briarwood’s Fellow

ship Hall

no later than 8:30 a.m. on the first day of cam

p. Transportation to Cam

p Chandler is

provided. $15.00 cash will be collected from

each camper attending Sessions A

, C, and D

at check-in for daily canteen. $10.00 cash w

ill be collected for campers attending Session B.

CH

ECK

-OU

T: Parents should pick up their children from C

amp C

handler no later than 10:00 a.m

. on the last day of the camp session. W

e encourage parents, however, to attend

the closing ceremony at 9:00 a.m

. Directions to C

amp C

handler can be downloaded from

our w

ebsite, campbriarw

ood.org.

MIN

I-WEEK

SESSION

FOR

3RD

AN

D 4TH

GR

AD

ES: This will be a W

ednesday–Saturday session and w

ill include all the activities of a full week, but at a low

er cost! Cam

pers should arrive at Briarw

ood Presbyterian Church no later than 8:30 a.m

. Wednesday for check-in.

Closing C

eremonies w

ill be at Cam

p Chandler on Saturday at 9:00 a.m

.

PAR

ENTS M

EETING

: A Parents M

eeting will be held Tuesday, June 6 from

7:00–8:00 p.m.

in the Chapel at Briarw

ood Presbyterian Church.

Registration closes for each session when it fills up. C

ampers’ registrations received after a session is full

will be put on a w

aiting list. Popular sessions often fill up in the first 3 weeks after registration begins.

TO SEC

UR

E A SPO

T, we m

ust receive: • A

registration card with both sides com

pleted, for each camper.

• A non-refundable deposit for each cam

per: Day C

amp – $50, O

vernight Cam

p – $100• Sorry, w

e can’t take credit or debit cards.

TO K

EEP YOU

R SPO

T, we m

ust receive the balance of your camp fee by June 5. O

n June 6 w

e may fill the spots of unpaid cam

pers with those on the w

aiting lists.

Some scholarships m

ay be available and are awarded based on need. Please contact the

camp office for an application. Scholarship applications are due A

pril 29.

Cam

p Briarwood does not discrim

inate on the basis of any race, color, national or ethnic origin, or religion in adm

inistration of its policies or admission.

WH

AT TO W

EAR

/BRIN

G TO

CA

MP: (Please label everything)

Day C

amp: Shorts, t-shirt, socks, closed-toe shoes (lace-up or Velcro), sw

imsuit &

towel

in w

aterproof bag

(each day

of cam

p). Thurs.

Overnight:

Sleeping bag,

pillow,

toothbrush, toothpaste, and pajamas. **N

o sports or fishing gear needed.

Overnight

Cam

p: long

pants (for

hiking and

horseback riding),

shorts, shirts,

swim

suit (no

bikinis), 2

pair shoes

(one pair

of closed-toe

shoes), jacket,

pajamas,

underwear (for each day), robe, tow

els (bath & beach), blanket, 2 sheets O

R sleeping bag,

pillow, w

ashcloth, toothbrush, toothpaste, flashlight, comb, soap, Bible, notebook, pencil,

stamps, stationery, and hair dryer. O

PTION

AL: battery operated fan

RECR

EATIO

NO

UT

REACH

If you have any questions, please call the camp office at 776-5237. Registration m

ay be dropped off at Briarw

ood Presbyterian Church in the C

amp O

ffice (G-100) or

mailed to: C

amp Briarw

ood, 2200 Briarwood W

ay, Birmingham

, Alabam

a, 35243.

For more inform

ation, check our website at C

ampB

riarwood.org.

SessionEntering G

radesD

ays of W

eekD

atesC

ost

11st–3rd

Mon–Fri

June 12–16$365

21st–3rd

Mon–Fri

June 26–30

$365

SessionEntering G

radesD

ays of W

eekD

atesC

ost

A4th–6th

Mon–Sat

June 26–July 1

$535

B3rd–4th

Weds–Sat

July 5–8

$435

C5th–7th

Mon–Sat

July 10–15

$535

D7th–10

thM

on–SatJuly 17–22

$535

DAY

CA

MP:

OV

ERN

IGH

T CA

MP:

LOC

ATION

: Day C

amp is held at Y

MC

A C

amp H

argis, located approximately 15 m

iles from

Briarwood Presbyterian C

hurch. Cam

p will be held from

8:30 a.m until 3:15 p.m

. each day. Lunch is provided each day at H

argis.

AC

TIVITIES: Each session includes hiking, sw

imm

ing, arts and crafts, canoeing, B.B. guns and archery. Bible stories and songs help children grow

in their relationships with each

other and with G

od. Lunches and snacks are provided each day.

CO

UN

SELOR

S: A ratio of approxim

ately 6 campers to each counselor ensures that each

child will receive personal attention. C

ounselors receive training in all aspects of camp.

CH

ECK

-IN: Each session runs from

Monday through Friday. C

ampers and a guardian

should arrive at Briarwood’s church Fellow

ship Hall on M

onday at 8:00 a.m. for check-in

and information. Tuesday–Friday cam

pers should arrive at 8:30 a.m.

CH

ECK

-OU

T: Each day at 3:15 p.m. from

the Briarwood Presbyterian C

hurch gym.

Anyone picking up a cam

per must be approved by the cam

per’s guardian in writing, and

be ready to show a current driver’s license.

THU

RSD

AY SPEN

D-TH

E-NIG

HT: Som

e sessions offer the option to spend the night on Thursday. These w

ill be held at Briarwood C

hurch and will include a night full of

activities, games, m

ovies, music, w

orship and more–even som

e sleep! A pizza party

supper Thursday night and Friday morning breakfast of juice, m

ilk, cereal and pastries are included. C

ampers should bring sleeping bag, tooth brush, pillow

, etc.

PAR

ENTS M

EETING

: A Parents M

eeting will be held Tuesday, June 6 from

5:30–6:30 p.m.

in the Chapel at Briarw

ood Presbyterian Church.

Special Connections C

amp is a C

hristian camp for boys and girls w

ith mild to m

oderate disabilities. C

amp Briarw

ood partners with the Special C

onnections ministry, a com

munity

outreach to families touched by disability. For m

ore info, call 776-5291.

AC

TIVITIES: Each special cam

per participates with typically-developing cam

pers in the full range of cam

p activities.

CO

UN

SELOR

S: Each camper is assigned his/her ow

n counselor for the week. The

counselors are able to attend to the campers’ needs and provide support in order for the

camper to participate w

ith a typical camp group. C

ounselors are trained to understand specific disabilities of the cam

pers. Strong emphasis is placed on cam

per safety and each counselor is trained in safety techniques.

DETA

ILS: There are Day C

amp and O

vernight Cam

p sessions available for special needs cam

pers during select weeks. The cam

p rates, schedule, check-in/check-out procedures, activities and attire are the sam

e for campers w

ith disabilities as for campers w

ithout disabilities. Please refer to the other pages of this brochure for this inform

ation.

REG

ISTRATIO

N PR

OC

ESS: Upon receipt of your registration form

and deposit, Special C

onnections staff will contact you to discuss your cam

per’s specific needs, which sessions

are available and to answer your questions. C

onfirmation of your cam

per’s placement in a

session will only be m

ade after contact with the Special C

onnections staff.

CAMPBRIARWOOD2017 REGISTRATION FORM

PLEASE CONTINUE ON REVERSE

________________________________________________________ Last Name First Name child goes by

________________________________________________________ Date of Birth Age Sex Grade (Entering in Fall)

________________________________________________________ Child’s Address

________________________________________________________ City State Zip

________________________________________________________ Father/Guardian’s Name Cell Phone #

________________________________________________________ Mother/Guardian’s Name Cell Phone #

________________________________________________________ Primary Email Address Home Phone #

________________________________________________________ Emergency Contact Name Phone #

________________________________________________________ Physician’s Name Phone #

PLEASE FILL OUT COMPLETELYTo secure a spot for camp, please complete a separate card for each child and send with a non-refundable deposit of:

$50 (Day Camp) or $100 (Overnight Camp), and mail to: Camp Briarwood, 2200 Briarwood Way, Birmingham, AL 35243

CAMP SESSION (Please circle one):

Day Camp: 1 2 Please register me for After-Camp Care for an additional $40/week ( )

Overnight: A B C D Special Connections: Day Camp Overnight CampIf your child is attending as a special needs camper, please contact June Cork, Director, Special Connections at 776-5291.

I WOULD LIKE TO ORDER THE FOLLOWING:

( ) Camp T-Shirt–$15 ( ) Camp Group Photo–$8Quantity___________ Quantity___________T-Shirt Size (Please circle one):Y-S Y-M Y-L A-S A-M A-L A-XL

CHOICE OF ROOMMATE OR GROUPMATE:_______________________________________________First Choice Second Choice _______________________________________________Full Name of Church Now Attending

For Office U

se Only

Cut Here

LOC

ATION

: Overnight C

amp is held at Y

MC

A C

amp C

handler, located on Lake Jordan near W

etumpka, A

L. Covering 475 acres, C

amp C

handler is the perfect setting for a week

of fun and growth.

AC

TIVITIES: O

vernight Cam

p offers activities such as canoeing, sailing, skiing, riflery, archery, arts and crafts, horseback riding, and a high ropes course that thrills every participant. C

ertain activities are available for specific age groups.

CH

ECK

-IN: Each cam

per and a guardian should arrive at Briarwood’s Fellow

ship Hall

no later than 8:30 a.m. on the first day of cam

p. Transportation to Cam

p Chandler is

provided. $15.00 cash will be collected from

each camper attending Sessions A

, C, and D

at check-in for daily canteen. $10.00 cash w

ill be collected for campers attending Session B.

CH

ECK

-OU

T: Parents should pick up their children from C

amp C

handler no later than 10:00 a.m

. on the last day of the camp session. W

e encourage parents, however, to attend

the closing ceremony at 9:00 a.m

. Directions to C

amp C

handler can be downloaded from

our w

ebsite, campbriarw

ood.org.

MIN

I-WEEK

SESSION

FOR

3RD

AN

D 4TH

GR

AD

ES: This will be a W

ednesday–Saturday session and w

ill include all the activities of a full week, but at a low

er cost! Cam

pers should arrive at Briarw

ood Presbyterian Church no later than 8:30 a.m

. Wednesday for check-in.

Closing C

eremonies w

ill be at Cam

p Chandler on Saturday at 9:00 a.m

.

PAR

ENTS M

EETING

: A Parents M

eeting will be held Tuesday, June 6 from

7:00–8:00 p.m.

in the Chapel at Briarw

ood Presbyterian Church.

Cam

p Br

iarw

ood

was

est

ablis

hed

in 1

964

by B

riarw

ood

Pres

byte

rian

Chu

rch

as a

Chr

istia

n ca

mp

for

boys

and

girl

s. T

he c

amp

is l

ed b

y Q

uest

Rec

reat

ion

Out

reac

h, a

spo

rts

and

recr

eatio

n m

inis

try

with

a g

loba

l re

ach

unde

r th

e su

perv

isio

n of

Bria

rwoo

d C

hurc

h.

Each

ses

sion

of

cam

p is

des

igne

d to

offe

r su

mm

er a

dven

ture

s yo

ur c

hild

will

ne

ver

forg

et.

Cam

p pr

ovid

es a

n id

eal a

tmos

pher

e w

here

the

phy

sica

l and

the

sp

iritu

al b

lend

tog

ethe

r. Bi

ble

disc

ussi

ons,

sto

ries,

son

gs a

nd v

espe

r se

rvic

es

help

chi

ldre

n gr

ow in

thei

r re

latio

nshi

ps w

ith G

od a

nd o

ther

s.

Cam

p Br

iarw

ood

is a

pla

ce o

f lif

e-ch

angi

ng e

xper

ienc

es.

Each

yea

r, ca

mpe

rs

com

e fr

om s

ever

al s

tate

s ac

ross

the

U.S

.

The

grou

ps fo

r ea

ch c

amp

are

as fo

llow

s:•

DAY

CA

MP:

Ent

erin

g G

rade

s 1s

t–3r

d•

OV

ERN

IGH

T C

AM

P: E

nter

ing

Gra

des

3rd–

10th

• SP

ECIA

L C

ON

NEC

TIO

NS:

Cam

pers

with

dis

abili

ties

CONSENT & RELEASE FOR MEDICAL TREATMENT & ACTIVITIESCAMPER NAME: ________________________________________________________________________________________________________

1. In the event that my child named on the reverse side becomes ill or is injured while under the supervision of Camp Briarwood, I authorize the Camp authorities to do the following: a. Contact the parent of legal guardian of the camper and follow his or her instructions; b. In the case of an emergency, when neither parent nor a guardian can be reached immediately, Camp authorities are authorized to use best judgment in contacting a physician or other health care provider and to authorize the provision of necessary medical, surgical, or other care; c. By this CONSENT, I appoint the proper Camp authority as my attorney-in-fact for the purposes herein stated. 2. I give consent for my child to participate in all activities at Camp Briarwood. 3. I am attaching any special instructions, in regard to my child’s allergies, medications, or specific needs, to this form. 4. In consideration of Briarwood Presbyterian Church making available Camp Briarwood and for the other benefits that I and my child receive, I do hereby release and discharge Briarwood Presbyterian Church, Camp Briarwood, its agenda and employees, from all liability of any kind or nature, claim, demand or cause of action which might be asserted. I understand that this is a RELEASE and with that knowledge, I voluntarily sign it.

______________________________________________________________________________________________________________ Parent/Legal Guardian Printed Name Signature Date

PHOTOGRAPHY CONSENTI understand that photographs taken of campers during their sessions may be used on the Camp Briarwood, Quest Recreation Outreach and Briarwood Presbyterian web pages and for promotions in brochures, displays, newsletters, fundraising and other items of publicity.

( ) I hereby give my permission to Camp Briarwood to use photographs taken of my camper. ( ) I do not give permission to Camp Briarwood to use photographs taken of my camper.

______________________________________________________________________________________________________________ Parent/Legal Guardian Printed Name Signature Date

Cut Here

Non-Profit Org.U.S. Postage

PAIDPermit #2143

Birmingham, AL

CAMP BRIARWOOD SUMMER 20172200 Briarwood Way, Birmingham, AL 35243ADDRESS SERVICE REQUESTED

Cam

p Br

iarw

ood

was

est

ablis

hed

in 1

964

by B

riarw

ood

Pres

byte

rian

Chu

rch

as a

Chr

istia

n ca

mp

for

boys

and

girl

s. T

he c

amp

is l

ed b

y Q

uest

Rec

reat

ion

Out

reac

h, a

spo

rts

and

recr

eatio

n m

inis

try

with

a g

loba

l re

ach

unde

r th

e su

perv

isio

n of

Bria

rwoo

d C

hurc

h.

Each

ses

sion

of

cam

p is

des

igne

d to

offe

r su

mm

er a

dven

ture

s yo

ur c

hild

will

ne

ver

forg

et.

Cam

p pr

ovid

es a

n id

eal a

tmos

pher

e w

here

the

phy

sica

l and

the

sp

iritu

al b

lend

tog

ethe

r. Bi

ble

disc

ussi

ons,

sto

ries,

son

gs a

nd v

espe

r se

rvic

es

help

chi

ldre

n gr

ow in

thei

r re

latio

nshi

ps w

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CONSENT & RELEASE FOR MEDICAL TREATMENT & ACTIVITIESCAMPER NAME: ________________________________________________________________________________________________________

1. In the event that my child named on the reverse side becomes ill or is injured while under the supervision of Camp Briarwood, I authorize the Camp authorities to do the following: a. Contact the parent of legal guardian of the camper and follow his or her instructions; b. In the case of an emergency, when neither parent nor a guardian can be reached immediately, Camp authorities are authorized to use best judgment in contacting a physician or other health care provider and to authorize the provision of necessary medical, surgical, or other care; c. By this CONSENT, I appoint the proper Camp authority as my attorney-in-fact for the purposes herein stated. 2. I give consent for my child to participate in all activities at Camp Briarwood. 3. I am attaching any special instructions, in regard to my child’s allergies, medications, or specific needs, to this form. 4. In consideration of Briarwood Presbyterian Church making available Camp Briarwood and for the other benefits that I and my child receive, I do hereby release and discharge Briarwood Presbyterian Church, Camp Briarwood, its agenda and employees, from all liability of any kind or nature, claim, demand or cause of action which might be asserted. I understand that this is a RELEASE and with that knowledge, I voluntarily sign it.

______________________________________________________________________________________________________________ Parent/Legal Guardian Printed Name Signature Date

PHOTOGRAPHY CONSENTI understand that photographs taken of campers during their sessions may be used on the Camp Briarwood, Quest Recreation Outreach and Briarwood Presbyterian web pages and for promotions in brochures, displays, newsletters, fundraising and other items of publicity.

( ) I hereby give my permission to Camp Briarwood to use photographs taken of my camper. ( ) I do not give permission to Camp Briarwood to use photographs taken of my camper.

______________________________________________________________________________________________________________ Parent/Legal Guardian Printed Name Signature Date

Cut Here

Non-Profit Org.U.S. Postage

PAIDPermit #2143

Birmingham, AL

CAMP BRIARWOOD SUMMER 20172200 Briarwood Way, Birmingham, AL 35243ADDRESS SERVICE REQUESTED