Name: ______________________ Age: ___ Birth Date: __________
                                    Address: ______________________________________________
                                    Town:_____________________________ Phone:______________
                                    Jr. Grange#:____________Or Subordinate Grange #:_____________ 
                                    Non-Grangers___________

 

                                    FOR JUNIORS:
                                    All medications for Juniors must be checked into 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 25 through noon on June 28, 2010.
                                    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 OF JUNIORS

                                    We give _______________________________________

                                    Permission to attend the 2010 Idaho State Junior/Family Camp at Farragut 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 in route.

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

                                    _______________                                                                _______________________
                                                    Date                                                                               Signature of Parent or Guardian

                                                                                                                                                                    __ ____________________
                                                                                                                                                                       Telephone Number

 

                                                                                                           

         

 

Junior Grange Camp
&
Family Adult Camp

Registration

June 25 to June 28, 2010
Farragut State Park, Bayview, Idaho