Child's Name: _______________________________

Address: ____________________________________

City: ____________________ Zip: ______________

Birthday ____/____/____ Phone _____ - _________

Emergency contact person: _______________________ Relation: _________________

Phone: _____ - ________ Cell Phone or Beeper: _____-________

I (we) agree that ___________________ WILL attend the House of Joy Church Bowl-A-Thon on April 23rd from 1:00 PM – 5:00 PM. I also give permission for my child to collect funds for the Bowl-A-Thon and I agree that all of the funds raised WILL be turned in by May 4th, 2005. This event will take place at a bowling alley near Oklahoma Ctiy (TBD). Transportation to and from the bowling alley will be provided from HOJC. I (we) understand that in the event that medical treatment is required, every effort will be made to contact me. However, if I cannot be reached, I give permission to the Royal Rangers staff to secure medical services to provide the care necessary for my child's well being.  

I (we), as Parent(s), understand that the National, Regional, Conference, or Outpost Royal Rangers staff while striving to insure a wholesome, safe, and closely supervised environment for boys in its care, cannot be liable for any unforeseen and/or unforeseeable accident or injury which may occur during the course of any Ranger activity. Responsible leaders, persons and acting agents transporting on behalf of the Rangers Ministry of the Pentecostal Holiness Church, assume no personal liability in case of accident or sickness.

Signature of Parent/Guardian: ___________________________ Date: ______________

Please list any medical and food allergies, medications being taken, medical problems, or other pertinent information on the backside of this form.

Please meet at HOJC at 1:00 PM Saturday.
Arrange for your children to be picked up at 5:00 PM.