Date: ____________________________________

I, the undersigned parent or guardian, hereby consent to my child:


______________________________________________________

Participating in CAMP HARMONY 2007, July 16-20, 2007, sponsored by the First Baptist Church of San Lorenzo Valley, in the event of an emergenty I may be reached at one of the phone numbers listed below. If I cannot be reached wihin a reasonable period of time, I hereby authorize the Camp Harmony adult staff to make emergency medical decisions for my child.

Parent or Guardian signature:


______________________________________________________  Date________

Medical conditions to be aware of:

Physical Restrictions:

Emergency Phone Numbers:

____ I do not grant permission for Camp Harmony to use pictures of my children in brochures, flyers, or websites. If this box is not checked Camp Harmony will assume that we have your permission to use photos that include your child in publicity materials.