The Isabelle Carter Arts Program

Sponsored by St. Michael's in the Hills Church

4718 Brittany Road, Toledo OH 43615

419-531-1616

office@lovelearnserve.org 

Name and phone number(s) of person(s) other than parents allowed to pick up your child

Any special instructions, such as custody or restraining orders must be attached to this application and discussed with the program director. All information will be kept confidential.

Parent Authorization and Student's Medical Information Form

St. Michael's in the Hills Church does not discriminate on the basis of race, color, sex, handicap, religion or national origin. St. Michael's in the Hills Church reserves the right at its sole discretion to refuse an application or dismiss a child from camp.

Parent/Guardian's Signature: I understand and accept these guidelines

I give St. Michael's in the Hills Church permission to photograph and/or videotape my child for public relations and/or marketing purposes. Photos will remain archived at St. Michael's in the Hills Church and can be used for promotional purposes without notification.

I understand that St. Michael's in the Hills is not responsible for participants who self-transport (walkers, bikers) once they leave church property.

I give permission for St. Michael's in the Hills Church to transport my child off the property for the purpose of emergency medical care.

I authorize St. Michael's in the Hills Church to act as the agent of the parents in any emergency situation or to administer basic first aid for the health and welfare of the camper involved. I am responsible for the expenses involved if the services of a physician or hospital are required.