2025 WINTER RETREAT

Health and Consent Form

Camper Name

First Name

Last Name

Church /Group Attending With

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact

Emergency Contact Name

First Name

Last Name

Relationship to Camper

Emergency Contact Phone Number

(###)

###

####

Allergies and Type of Reactions

If you have food allergies and/or dietary needs please fill out the FOOD ALLERGY FORM at: aowakiya.org/food-allergy

Special Conditions/Physical Limitations

Parental Consent

I hereby give permission to "Camp Ao-Wa-Kiya", which is licensed by the Department of Consumer and Industry Services, to secure emergency/non-emergency medical and/or surgical treatment for the minor child named above. I further release Camp Ao-Wa-Kiya from all liability beyond the limits of their insurance coverage.

DON’T WANT TO DO IT ONLINE. CLICK HERE FOR PRINTABLE PAPER COPY