<p> Wilsall Community Church Junior Rodeo Bible Camp 2017 June 23-25 (Friday, Saturday, Sunday) Registration Form Notice: This is an OVERNIGHT CAMP for children entering 4th through 6th grade. Boys and girls will be sleeping in separate tents with constant supervision. This is a DAY CAMP for Pre-K through 3rd grade. There is NO COST for this camp. Camper Information Name: ______Birth Date: ______Grade: ______Gender: M F Address: ______City: ______State: ______Name of Parent(s)/Guardian: ______Phone: ______Emergency Contact (different from above): ______Phone: ______Emergency Contact (different from above): ______Phone: ______T-Shirt Size: Kids: Ex. Small _____Small_____ Medium_____ Large_____ Adult: Small______Med.______Lrg.______Ex. Lrg____ I want my child to wear protective headgear while riding horses: ______Signature</p><p>General Information (campers need to select TWO events for the Rodeo) I give my child permission to participate in any of the listed activities below EXCEPT: (check all those that you will NOT allow) o Mutton Bustin (50 lbs. & o Horse riding (supervised) o Pole Bending under) o Dummy Roping o Steer Riding o Barrel Racing (on foot for o younger kids) o Goat Tying o The Two Events child will compete in are: ______and ______. o Medical Information o Is your child taking any medication (prescription OR over-the-counter)? YES NO (circle one) If yes, please list and explain: ______o ______o o o Circle any allergies: Hay Fever Insect Sting Penicillin Asthma Other (list):______o o Please list any food allergies/dietary restrictions: ______o o Describe any EFFECTS from all allergies listed: ______o o In order to provide for your child’s medical needs, please indicate (by circling) how we will be allowed to treat your child: o o Put on bandage Apply antibiotic ointment Cleanse wounds Remove splinters Take children’s Tylenol Apply ice pack o o Please list anything you DO NOT WISH MEDICAL PERSONNEL TO USE ON YOUR CHILD ______o List any known medical conditions about your child that may assist us: ______o ______o o Health Insurance Company Name (required): ______Policy Number (required): ______o o Liability Release: o Wilsall Community Church – JUNIOR RODEO BIBLE CAMP MEDICAL WAIVER FORM o Release and Medical Authorization o In order for a child to participate in the Wilsall Community Church Junior Rodeo Bible Camp activities, a parent or guardian must sign this release and medical authorization. o Release and Liability o In consideration of the Wilsall Community Church Junior Rodeo Bible Camp, I grant the child permission to participate in the Rodeo Bible Camp. I hereby assume all risks of his/her personal injury that may result from Rodeo Bible Camp activity. As a parent/guardian, I do hereby release Wilsall Community Church, owners and managers of venue location, all instructors and all participants in said Rodeo Bible Camp program from liability; including but not limited to claims and suits at law or inequity, for any injury or damage to livestock and/or personal property which may result from the child taking part in Rodeo Bible Camp activities. o o Medical Authorization o I hereby authorize and give my consent to the health authorities of Wilsall Community Church or any licensed physician or EMT to perform or administer any reasonable, necessary medical attention including transporting to the nearest appropriate medical facility to:______(Camper’s Name ). o o I agree to assume all costs related to such treatment. I understand that I will be responsible for any medical or other charges in connection with child’s attendance to this camp. o o ______o Parent/Guardian Signature Date o o Return Form to: Wilsall Community Church PO Box 92 Wilsall, MT 59086 o OR o Scan completed form and email to: [email protected] o o SCHEDULE: o FRIDAY:  8--9:30am Registration/check-in: 153 North Fork Horse Creek Road (camp address).  12:45 pm Pick up pre-K through 3rd grade at Camp. o o SATURDAY:  8:45 am Drop off pre-K through 3rd grade at Camp.  12:45 pm Pick up pre-K through 3rd grade at Camp. o o SUNDAY:  8:45 am Drop off pre-K through 3rd grade.  10:00 am Church (at the location below).  11:30 am Lunch (Grab and Go to Rodeo)  12:00 pm Rodeo Performance. (Rodeo will be substantially shorter than last year !).  2:00 pm Pick up all kids after rodeo performance. o o LOCATION: o 153 North Fork Horse Creek Road, Wilsall, MT o (5 ½ miles east of Wilsall on Horse Creek Rd; then 1 ½ miles north on North Fork Horse Creek Road). o o o PHONE NUMBER AT RODEO BIBLE CAMP: ______o o INFORMATION: o Duane or Judy Vincent 406-578-2190 o Tucker or Kaitlyn Boyd 406-220-2474 o Duane or Janet Clark 406-578-2327 o Mark or Cindy Danielson 406-599-0074 o o</p>