NAME: ___________________________________________________________________________ AGE:____________


ADDRESS _________________________________________________________PHONE____________________


__________________________________________________________EMERGENCY PHONE____________________

Parent/Camper Agreement
In case of medical emergency, I hereby give permission to the physician selected by the director or staff member in charge to secure proper treatment for my child in the event of accident or injury.  I release and agree to indemnify Camp Berea and any of its representatives from all claims, damages, actions, or causes of action arising therefrom.  I agree that my child is in good health and grant permission for him/her to participate in all camp activities.

Parent or Guardian:_________________________________________________     Date:_________________

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