SPONSOR IS EXPECTED = TO MAKE COPI

3D"Awanita

SPONSOR IS EXPECTED TO = MAKE COPIES=20 FOR EACH CAMPER

NOTE: WE = RESERVE THE=20 RIGHT TO REFUSE ANYONE WHO DOES NOT HAVE AN AWANITA VALLEY LIABILITY = RELEASE=20 FORM SIGNED BY THE PROPER INDIVIDUALS.

If there are existing medical limitation; including allergies, which = would=20 affect or limit you or your child's participation in any camp activity, = or of=20 which medical personnel should be made aware, please indicate below. = Without=20 such notice, it will be assumed that you or your child is physically fit = and=20 mentally capable of participation in ALL activities.

______________________________________________________________________= _______________________

** NOTIFY THE LEADER OF YOUR GROUP OF ANY MEDICAL LIMITATIONS OR = SPECIAL=20 NEEDS.

** THE LEADER OF YOUR GROUP IS RESPONSIBLE FOR TAKING CARE OF THESE = SPECIAL=20 NEEDS.

Awanita Valley, Donald E. Baltz Foundation, and=20 ________________________________________________
&nb= sp; &nbs= p; = ; = &= nbsp; &n= bsp; &nb= sp; =20 Church or Group = Name
including=20 employees and representatives of the aforementioned organizations shall = be held=20 harmless from any suit, action, damages, or claims at law or otherwise = resulting=20 from or arising out of any injury, accident, or illness which may befall = on=20 ______________________________________________________ and his/her=20 property
&= nbsp; =20 &= nbsp; =20 Name of Camper
while a camper at Awanita Valley. If the = camper=20 is a minor, this covenant is applicable to the camper and his/her = parents or=20 guardian.

The undersigned parent or guardian hereby authorizes=20 ________________________________________=20
&nb= sp; &nbs= p; = ; = &= nbsp; &n= bsp; &nb= sp; &nbs= p; =20 Church or Group Name
or = employee to take=20 such action as may be necessary for the medical care or treatment = including the=20 administration of medication, permission for surgery, or such other = action as=20 needed in the event of injury, accident, or illness of camper or when = parent or=20 guardian cannot be reached for authorization. In the event the = authorized=20 person refuses or is not able to act, Awanita Valley personnel are = authorized as=20 set forth above. This authorization may be presented to medical = personnel=20 without liability of said personnel to seek further authority.

______________________________________________________ = Date=20 ______________________
Signature of Camper

_______________________________________________________ Date=20 ________________________
Signature of Parent/Guardian, if camper is = under 18=20 years of=20 age
= &= nbsp; &n= bsp; &nb= sp; =20