Junior Grange Camp
&
Family Adult Camp

Registration

June 26  to June 29, 2009
Farragut State Park, Bayview, Idaho

                      Name ___________________________ Age:___   Birthdate:___________
                      Address: _____________________________________________________
                      Town:____________________________   Phone: ____________________
                      Jr. Grange #: __________         OR  Subordinate #:____________________
                      Non-Grangers ___

 
                      FOR JUNIORS:
                      All medication for juniors must be checked in to the Camp Director!
                      Medication (properly labeled) ____________________________________
                      Allergies or Restrictions: ________________________________________

                      CAMP FEE:  $30.00 fee must accompany registration
                       Camp runs from 3 p.m. on June 26 through noon on June 29, 2009
                         Adults please fill out registration form and enclose camp fee


                      Send by June 1st to:                Idaho State Grange
                                                                        P.O. Box 367
                                                                        Meridian, ID 83680-0367

 
                      CONSENT FORM FOR PARENT OR GUARDIAN FOR JUNIORS

                     We give ___________________________________________________

                      Permission to attend the 2009 Idaho State Junior/Family Camp at Farragut State
                      State Park, Bayview, Idaho; and agree not to hold Idaho State Grange Junior
                      Camping Staff and Directors responsible for losses, injuries, or accidents at
                      camp or enroute.

                      In case of EMERGENCY, I give consent for the Camp Director to have my child treated.

                    _____________________                                ______________________________
                                   Date                                                        Signature of Parent or Guardian                                            

                                                                                                      ________________________
                                                                                                             Telephone Number