American Indian Field
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    Please read the entire form carefully. Thank you!
    PLEASE LIST ALL FAMILY MEMBERS THAT WILL BE ATTENDING FAMILY RETREAT


    LIABILITY RELEASE

    My family and I choose to participate in camp activities and understand we do this at our own risk. We will not hold SIMC liable for injury or loss of property.
    ​

    ​PHOTO RELEASE

    I give my consent to use my or my child/children's photograph, likeness or image, whether in still frame, voice or video format by World Gospel Mission/American Indian Field/SIMC in publications, promotional brochures, video presentations, on the world wide web and in display formats.

    MEDICAL RELEASE

    I give permission for first aid treatment to be given to me or my child/children if deemed advisable by the SIMC staff.
    Allergies: Do you or your child/children have any know allergies?
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A Ministry of World Gospel Mission
3783 East State Road 18
PO Box 948
Marion, IN 46952
Phone: (765) 664-7331
American Indian Field Headquarters
Southwest Indian Ministries Center
14202 N 73rd Ave.
Peoria, AZ 85381
Phone: (623) 979-6008
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