Please print these forms. After that, you may close this window to return to the Wilderness Page.

Please Mail them to:

Rev. Greg Odlin
231 Ocean House Road
Cape Elizabeth, ME 04107

Minimum age for participation is 15 yrs. old.

All participants must have a deposit of $200 in by May 15th!

Apply early!! Limited space!

Maine Wilderness River & Ocean Challenge Program
Registration Form

(Please print)

Name ______________________________ Date of Birth_____________

Address_____________________________________________________

City_____________________State_______Zip Code_________

Parent’s Name________________________________________________

Parent's Emergency Phone # -

(Home)_____________________________

(Cell)-______________________________

email address_____________________________________________________

Please read the "Code of Conduct" (below) with your parents and sign it and mail it in.

For more information, call Rev. Greg Odlin (207) 730-2225 or Rev. Jim Caron (207) 577-8538.

Maine Wilderness River & Ocean Challenge Program
Medical Information and Waiver Form

(please complete ONE FORM for EACH CHILD and return with Registration and payments)

 IN CASE OF EMERGENCY CONTACT:

Parent(s) _______________________________________________________________________

Phone ___________________________________ Cell Phone  ____________________________

ALTERNATE CONTACT:

Name __________________________________________________________________________

Phone ___________________________________ Cell Phone  ____________________________

Relationship _____________________________________________________________________

 HEALTH INFORMATION:

Do you have Medical Insurance?  Yes _____  No _____   Policy Number _____________________

Name of I____________________________________________________________

Has he/she been subject to any of the following (check if yes)?

_____Asthma               _____Allergies               _____Fainting spells _____Diabetes  _____Heart trouble _____Convulsions            Other, explain ______________________________________________________________

Does your child have any medical or emotional condition or concern that the staff should be watchful for:

_____ depression    _____ anorexia     _____bulimia     Other, explain: ____________________________________

 _____________________________________________________________________________________________

(Please note that this information will be held in confidence by the staff.)

The event nurse has my permission to administer Tylenol if my child has a fever over ______ degrees

Any current condition requiring medication? Yes _____  No _____

Name of medication and dosage ___________________________________________________

 PARENT AUTHORIZATION and LEGAL WAIVER

To my knowledge this medical history is correct. My child,/children _______________________________

_______________ are permitted to take part in all activities except, ______________________________

In the event I cannot be reached in an emergency, I give permission to the physician and hospital selected by the adult leader in charge to give whatever medical aid is necessary. In consideration of the activity staff and organization for the effort to provide the children with a nurturing and enriching experience, I hereby agree to assume complete responsibility for any costs, medical or other, incurred by my child while attending this event. I will not legally implicate the event staff or HSA-UWC.

 Signature (parent or guardian)________________________________________________________

 Print Name __________________________________________________ Date  ________________

Maine Wilderness River & Ocean Challenge Program
Code of Conduct

2. I will respect God. others and myself by wearing appropriate clothing at all times.  Clothing that is not too tight or too short.  Bikinis or European style swimming trunks are considered inappropriate.  Camp staff determines what is considered to be inappropriate.

3. I will respect God , others and myself by being on time to all camp activities, including fundraising activities.  Being late is considered selfish and holds the whole camp hostage to my individual agenda.

4. I will respect God, others and myself by observing 'lights out'.  The end of the day is as important as the beginning.  I understand that everyone gets the most out of camp (wilderness training) and fundraising on the foundation of a good nights sleep.

5.  I will respect God , others and myself be being very careful while out in the wilderness areas.  If we have an accident in the wilderness it is far more serious than if we were close to medical facilities.  What started out as a small medical condition could turn very serious in the wilderness.  Safety must be a top priority for all involved.  No fooling around needlessly.  

Signature _______________________________________________________________________

Parents Signature _______________________________________________________________________

Campers and parents name (Please Print Names) ______________________________________________________

Thank you for filling these forms out.

Now Please MAIL the Forms with your CHECK.

Rev. Greg Odlin
231 Ocean House Road
Cape Elizabeth, ME 04107