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SH Harvey Cedars Registration 2019 on Monday, July 8, 2019

Student Information
*Student's Current Grade
*Student's Gender
Student's T-Shirt Size (HCBC t-shirt included in the price)
Student's Requested Roommates (Please limit to 1-2 names. It is our desire to place each student in a room with at least one of their friends. However, due to room set-ups and counselor to student ratio's, we cannot guarantee they will be placed in the same room with all of their friends.)
Please list any specific dietary requirements that you would like us to communicate to the Harvey Cedars food service staff. (This does not guarantee that all requests can be accommodated. If and when possible, you should plan to send supplemental food items along with your student if they will be needed. Separate refrigeration is available and accessible in the dining hall for students to use for this purpose.)
If your student must arrive to or depart from Harvey Cedars Bible Conference apart from the group, please provide those details below.
If your student needs to be discharged early, who has permission to pick them up?
I, the undersigned parent/guardian, give permission for my student to depart camp apart from the group as noted above and my full printed name below represents my electronic signature.
PLEASE NOTE that in addition to the information above, you must submit a completed and signed student health form and a copy of their medical insurance ID card. The link to the health form is available on the previous page AND it will be sent to you as a link in your registration confirmation email. Or you can Click Here to access the form.


Parent Information
*Parent's Full Name
*Parent's Email Address
*Parent's Cell Phone #
Consents
*I, the parent/guardian of the above-named student, give permission for said student to attend and participate in activities at Harvey Cedars Bible Conference, including but not limited to, transportation by van/bus and any off-site trips, sponsored by West Shore Free Church, Mechanicsburg, PA, Monday, July 8 through Saturday, July 13, 2019.

I further agree to indemnify and hold harmless Harvey Cedars Bible Conference and West Shore Free Church, its employees, directors, officers, volunteers or agents for any injury, expenses or fees sustained related to the above referenced activities.

I further agree that if in the event that medical treatment is required for my student, every effort will be made to contact me. However, if I cannot be reached, I give my permission to the staff or sponsor to secure the services of a licensed physician to provide the care necessary, including anesthesia, for my student's well-being.

I further agree for Harvey Cedars Bible Conference and West Shore Free Church to use photos/videos taken during youth weeks (that may include my student) for various promotional purposes such as web site, brochures, etc.

I further agree that my student will abide by all of the rules and guidelines established by Harvey Cedars Bible Conference and West Shore Free Church. I understand that I will be contacted and my student could be sent home (without a refund) if the rules and guidelines are disregarded. And I also agree that I will be responsible to pay for any damages to facilities or private property caused by my student.

I further understand that students are not allowed to have cell phones at Harvey Cedars and that they must turn them in upon arrival and that any devices found during the week will be confiscated. (A list of leader cell numbers is available for parents at check-in in case a parent needs to speak with their student in an emergency.)

I, the undersigned parent/guardian, agree to all of the above statements and my full printed name below represents my electronic signature.
A $125 non-refundable deposit is due at the time of registration; all balances and health forms are due by April 3