JULY 25-27, 2008                                       2008 CAMP & CAMP TOURNAMENT REGISTRATION          (PRE-REGISTRATION DEADLINE IS JULY 18, 2008 __________________________   ____   ______________________________________________  _______ First name                                         MI             Last name                                                                        Age ___________________________________________________________   _____  _________________ Street or P.O. Box                                                                                               ST                Zip code Parent or guardian: _________________________        ________________________   _______________________                                        Name                                          Home telephone                        Work telephone Emergency contact #1:_______________________   ______________________         _______________________                                     Name                                        Relationship                                Telephone Emergency contact #2:_______________________   ______________________         _______________________                                     Name                                        Relationship                                Telephone Physician:  ____________________  ______________________________________          Name                                        Telephone Dentist:    _____________________  ______________________________________          Name                                        Telephone Please list below any allergies, medical conditions of which we should be aware, medications taken, or special diet requirements. _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________             PLEASE PRINT AND MAIL THIS FORM WITH YOUR CHECK OR MONEY ORDER Cost:  $100 ($90 pre-registered) for all activities, tournament, room and board.  $10 discount for second family member and each additional family member.  Group discounts:  10th member of any group is free. Please enclose your check or money order payable to Jim Riggs, 280 Mill St., Stark City, MO 64866 For information call:  (417) 472-3054 I hereby release Jim Riggs, Camp Cyokamo, and any other persons associated with the Christian Martial Arts Camp & Tournament held July 25, 26, 27, 2008 from any liability as a result of injury or sickness I or my dependent may sustain as a result of my attendance and participation in the camp, camp activities, and the Sunday tournament.  I also grant permission to Jim Riggs or other camp personnel to seek medical treatment for my son or daughter should they consider it necessary.  Efforts will be made to contact the parent of guardian in the case of an emergency. ________________________________________     __________________________________________ Camp participant (if 18 or older)                                Parent or Guardian