2008 Campus Life Trip Registration Form and Medical
Release
I agree not to hold CAMPUS LIFE responsible for any injury that may result from my son's/daughter's participation
in Campus Life Trip.
necessary during the trip and I further assume all
responsibility for the decisions so made.
Name________________________________________________________________________
Grade______________Home
Ph__________________Work Ph________________
Street ___________________________________P.O. Box ________________________
City/State____________________________________________
ZIP______________
Birth Date__________________
Insurance
Co.___________________________________________Policy#___________________
Signed:
Parent/Guardian _________________________________________________________
Date:__________________________
CAMPUS
LIFE CODE OF CONDUCT
It is desired to provide the best possible atmosphere throughout the trip.
Students are expected to cooperate with all
staff at all times. Possession and/or use of alcoholic beverages and/or any type of drugs is strictly prohibited. Failure
to remain within these guidelines at any time is cause for the student's immediate return home at the parent's/guardian's
expense.
We have read the code of conduct and agree to abide by it.
______________________________________________student
signature
Any questions call: Kim Harlow, Ken or Karen Mills at the Campus Life Office
269-651-1669 outside St. Joseph County 800-316-7268
Campus
Life is a division of Southwest Michigan Youth for Christ which serves
students in Branch and St. Joseph Counties.
As an organization we
encourage students to lead a balanced life. Please call if you would like
any other information
about our programs.
Register NOW!! Money Must Accompany Registration