1. CFC YOUTH – DALLAS
YOUTH CAMP REGISTRATION FORM
March 26-28, 2010
Camp El Har
5218 Kiwanis Rd
Dallas TX, 75236
$ 75.00 includes all camp materials, snacks and meals
Registration Due Date: March 19,2010
These forms must be both reviewed and understood carefully by all concerned. Please sign, date and return (or
mail, address on next page) to a Parent Coordinator or Camp leader on or before the due date.
Dear Parent(s) or Guardian(s):
Your child’s good health, physical, and emotional welfare is of prime importance and interest to us while he/she is
attending the Youth Camp. Since it may be difficult to contact you right away in case of an emergency, we ask that
you complete the medical information questionnaire and waiver/medical form as accurately as possible to help
assure that your child will receive prompt and specific medical attention in the event of an emergency.
Name of Participant: ________________________________________________ Age: _______
Participants e-mail: _______________________ Date of Birth: __________________________
Address: ______________________________________________________________________
Home phone: __________ Parent’s Cell phone: ___________ Parent’s E-mail ______________
Parent / Guardian name: _________________________________________________________
Family Doctor: ______________________________ Phone number: _____________________
Medications currently being taken or required: ________________________________________
Medications the participant may be allergic to: ________________________________________
Medical condition currently being treated for: ________________________________________
Items allergic to or gets a reaction from (if any): ______________________________________
Restrictions of physical activities that applies to Participant: _____________________________
Our signatures certify that all the above information is true and correct.
____________________________________
____________________________________
Signature of Participant Date Signature of Parent/Guardian Date

2. Please make checks payable to: COUPLES FOR CHRIST (CFC)
Mail this form and check to: Johnny and Fe Poquiz
1705 Skyline Drive, Garland, Texas 75043
Registration and check-in on Friday, March 26:
Starts at 6:00 pm. First Session starts at 8pm.
What to Bring:
Sleeping bag or bed sheet, blanket, pillow, clothes appropriate for the weather, toothbrush,
toothpaste, soap, shampoo, towel, pen and paper.
If your child is taking medication(s), please put these in a clear ziplock bag with his/her name on
it and give to Parent Coordinators Vangie Sabado and Marites Bonifacio for safe-keeping.
Parents are highly encouraged to come on Sunday morning to participate in a forum, have a
wonderful private dialogue with their son/daughter and fellowship with other families. You may
bring your favorite dish to share, if you desire. You will be called to confirm the time.
Parent Coordinators:
Johnny and Fe Poquiz 469-360-5036 jfpoquiz@tx.rr.com
Bonnie and Marites Bonifacio 469-767-0475 mtbonif@gmail.com
Globen and Vangie Sabado 469-235-8821 nebolg@yahoo.com
Rico and Luisa Villavicencio 214-546-7223 ricovillavicencio@yahoo.com
Dondon and Marigold Noguerra 972-345-3418 part97ct@yahoo.com
Dary and Dina Bowlin 972-523-2423 dalawa5@msn.com
Direction to Camp El Har:
From Dallas – Take 1-30 W; Exit 38 to merge onto TX-12 Loop S; Slight right at TX-408 Spur S
(signs for I-20/TX-408 Spur); take exit toward Grady Niblo Rd; left at S Merrifield Rd; take the
1st right onto Grady Niblo Rd; Grady Niblo Rd turns slightly right and becomes Kiwanis Rd.;
destination on the left.
From Fort Worth – Take I-35 S; exit 45B to merge onto 1-20 E toward Dallas; exit 460 to merge
onto TX-408 Spur N; take the Grady Niblo Rd exit; keep right at the fork, follow signs for Grady
Niblo Rd E; right at Grady Niblo Rd; Grady Niblo Rd turns slightly right and becomes Kiwanis
Rd.; destination on the left.
(KEEP THIS PAGE FOR YOUR REFERENCE)

3. WAIVER AND MEDICAL FORM
All participants, read and sign this form completely. If below 18, have parents/guardian sign.
I, the undersigned parent and/or guardian of the child, whose name appears below (hereafter
know as “participant”, hereby give my consent to attend the Youth Camp to be held at
Camp El Har, Dallas, Texas.
I understand that the above facility is covered by its own premise and general liability insurance
policy. In the event of any injury to the participant, this document fully release CFC-Youth and
all its members from any of the liability and/or responsibility which are not covered under the
policy held by the mentioned facility.
I understand that my child will be provided constant adult supervision. My child, as a participant,
will be able to follow directions, guidance and instructions in a proper manner at all times. By
signing below, I am certifying that my child is responsible and willingly accepts rules and
regulations.
I hereby authorize CFC-Youth to arrange for my child’s medical attention, diagnosis, treatment
and hospitalization and care in case of an emergency, after an unsuccessful effort has been made
to contact me.
I further hereby authorize and accept financial responsibility for any necessary first-aid, medical
and surgical treatment to be performed by a medical facility, including 911 emergency call, for
any injury or illness to my child occurring in any CFC-Youth sponsored activity, after reasonable
effort has been made to contact me.
CFC-Youth is therefore fully absolved and released from any responsibility and/or liability for
my child while engaged in any of the activities within the scope of the camp programs. I agree
and understand that I hold CFC-Youth harmless from all liabilities, costs, damages to any
property caused by or arising out of my child’s participation in the camp.
Name of Participant: ____________________________________
Signature: ________________________ Date _____________
Name of Parent/Guardian: _______________________________
Signature: ________________________ Date ____________