Summer Camp Registration Form

1Children Participating

2Contact Info

3Additional Info

4Consent & Release

5Total & Payment

1. CHILDREN PARTICIPATING

Camp Attendees

Child's Name	Birth Date	Any Known allergies and/or physical restrictions?	Any medication child is taking?	Actions

There are no Children.

Address(Required)

Street Address Address Line 2 City State ZIP Code

2. CONTACT INFORMATION

1st Parent / Guardian(Required)

First Name Last Name

Phone Number(Required)

Are you are a church member?(Required)

Yes

2nd Parent / Guardian

First Name Last Name

Phone Number

Are you are a church member?

Yes

Emergency contacts (in case parents can’t be reached):

Full Name(Required)

Phone Number(Required)

Relationship(Required)

Full Name

Phone Number

Relationship

3. ADDITIONAL INFORMATION

Question for the Parent(s): Are you interested in volunteering at the camp?

Yes

What can you help with?(Required)

Jobs: Mentor a child, Worship, Kitchen, Craft, Sport etc.

4. CONSENT & RELEASE

In case of emergency, every effort will be made to contact the parents and the emergency numbers listed above. Failing to reach any of the contacts, I give my permission to call a physician or emergency to secure proper emergency treatment. I hereby waive, release, and discharge any and all claims for damages for personal injury, property damages or which may hereafter occur as a result of participation in camp. This release is intended to discharge First Slavic Christian Church and its staff/volunteers.

Signature(Required)

Today's Date

5. TOTAL & PAYMENT

Payment Method(Required)

Camp Registration

Price: $0.00

Non-Church Member Fee

Price: $30.00

Late Registration Fee

Price: $0.00

Online Processing Fee

Price: $0.00

*Processing Fees will apply for online transactions through PayPal (3.49% + $0.49)

Total

Coupon