EmailMe Form - Emmanuel Summer Days Camps 2018

Parent's Name *

First Last

Parent's Name

First Last

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

Phone *

### - ### - ####

Phone

### - ### - ####

Email *

Emergency Contact information

Emergency Contact Name *

First Last

Emergency Contact Phone *

### - ### - ####

Doctor Name

First Last

Doctor Phone

### - ### - ####

Children's Info

Name of Child #1 *

First Last

Birthday of Child #1 *

MM / DD / YYYY

Grade Entering September 2018 *

Care Card # *

Camps Attended by Child #1 *

Health and Allergy Concerns (please describe)
Special needs will require further documentation and will require at least one month’s notice before the camp, in order to prepare appropriately.

Name of Child #2

First Last

Birthday of Child #2

MM / DD / YYYY

Care Card #

Camps Attended by Child #2

Health and Allergy Concerns (please describe)
Special needs will require further documentation and will require at least one month’s notice before the camp, in order to prepare appropriately.

Name of Child #3

First Last

Birthday of Child #3

MM / DD / YYYY

Care Card #

Camps Attended by Child #3

Health and Allergy Concerns (please describe)
Special needs will require further documentation and will require at least one month’s notice before the camp, in order to prepare appropriately.

Name of Child #4

First Last

Birthday of Child #4

MM / DD / YYYY

Care Card #

Camps Attended by Child #4

Health and Allergy Concerns (please describe)
Special needs will require further documentation and will require at least one month’s notice before the camp, in order to prepare appropriately.

I, the Participant, understand that I am responsible to act in a safe and responsible fashion and obey requests to comply with health and safety regulations as directed by the designated leaders and drivers. I will be responsible for myself and wear available seat belts and not distract the driver when going to or from this event. During activities necessitating such, I understand it is my responsibility to obtain and wear suitable safety equipment. I will not endanger the safety of myself and others, at any activity, or in transportation to and from such activities. As parent / guardian, I hereby authorize the Participant to attend the functions, events and activities that will be part of this event hosted by Emmanuel Baptist Church and release its staff and members from responsibility and liability for any injury or illness that my child may sustain during this event or in transit to and from this event.

As parent/guardian, I authorize the Participant to be transported by the designated leaders or drivers, or arrange for transport to the NEAREST SUITABLE MEDICAL OR HOSPITAL FACILITY in the event of an emergency situation that is not treatable at the scene. In such an emergency, I hereby authorize a supervising adult of the activity, as my agent, to consent to any medical/dental diagnoses and treatment advised and supervised by a physician, surgeon or dentist (as appropriate). I expect to be contacted as soon as possible.

I recognize that photos and videos of my children may be taken and used within the camp and church. Images will not be used in advertising outside the church unless permission is granted below. *

I Agree

I permit Emmanuel Baptist Church to make use of images of the my children (moving or still) for the sole purposes advertising future camps in print, live presentations and web communications so long as names are not identified. *

I give my permision

I do NOT give my permission

Refund Policy

If a registered camper is withdrawn from a camp, Emmanuel Baptist Church will observe the following refund policy:

Full refund if withdrawal is more than 31 days from the camp date.

50% refund if the withdrawal is within 31 days of the camp date; 100% if the camper’s space can be filled from a waiting list before the camp starts.

No refund if withdrawal takes place during the camp dates. *

I agree

How did you hear about Emmanuel Summer Camps *

Spiritual interest Survey *