Child's Name *

First Name

Last Name

Emergency Phone Number

Contact For Camper Emergency

(###)

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Alternate Contact Phone

Contact When Parent/Guardian Is Unavailable

(###)

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Parent/Guardian Name *

First Name

Last Name

Parent/Guardian Phone Number *

(###)

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Permission *

By Checking The Box Below, I do give Muskogee First Assembly of God, located at 3100 Gulick St. Muskogee, OK 74403, permission to take my child (listed on this form) to and from Camp Cargill, located at 347489 E. 990 Rd. Sparks, OK 74869. I, hereby, release all liability from the driver and all those working with Muskogee First Assembly of God during this transportation on July 15 and July 19. I do understand that all leaders will do their utmost to insure every child’s safety both during transportation and once they arrive at their destination.

I Give Consent