Camp Registration

Notes:
-All Campers MUST be 3-6 years old and potty trained
-Mtn Park UMC Students will be invoiced directly through Procare
-Complete 1 Application Per Child
Camper Information
Camper Name*

First NameLast Name
Age*
Date of Birth*

MonthDayYear
Date
Gender*
Registered Student at Mountain Park UMC Preschool?*

YesNo
Medical Information
Please let us know if you have any allergies, existing illnesses or any medical conditions.*
Are you currently taking any medication? If yes, please provide the generic name and its purpose?*

Parent/Guardian Details
Parent/Guardian Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Details

If parent/guardian cannot be reached.
Contact Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Relationship*

Payment Details

$125 Per Week
How many weeks are you registering for?*

Waitlist- Prehistoric Party: June 2-6, 2025 - Camp FULLWaitlist- Moovin' and Groovin': June 9-13, 2025 - Camp FULLWaitlist- Out of this World!: June 16-20, 2025 - Camp FULLCamping Adventures: June 23 - 27, 2025 (2 Spots remaining)
Payment Method*
Cash or Checks can be dropped off or mailed to: Mtn Park UMC Preschool 1405 Rockbridge Rd SW Stone Mtn, GA 30087
Acknowledgment, Authorization, and Waiver
I hereby certify that my child(ren) is/are in good physical condition and do/does not suffer from any disability that prevents their participation in all activities of Mountain Park UMC Preschool Summer Camp. I acknowledge that Mountain Park UMC Preschool will not assume any responsibility or liability for personal injury or damages caused by an injury. In the event Mountain Park UMC Preschool is unable to reach a parent, guardian, or any emergency contact, I hereby give permission for my child(ren) to be transported to the nearest hospital for treatment in case of an accident or emergency. I hereby further authorize(s) any of the staff or employees to provide for, approved and authorize health care at the hospital.
Yes*
I release Mountain Park UMC Preschool and any of its staff and director for any responsibility in case of accident, illness, or injury during this camper's enrollment.
Yes*
I hereby grant and authorize Mountain Park UMC Preschool the right to take, edit, copy, publish, distribute, and make use of any and all pictures or video taken of my child(ren) to be used in/or for legally promotional materials and digital communications.
Yes No*
Date Signed*

MonthDayYear
Date
Parent/Guardian Signature*

Powered by Jotform SignClear
Mountain Park United Methodist Church
1405 Rockbridge Road Southwest, Stone Mountain, GA 30087
470-395-6035 - preschool@mountainparkumc.org - www.mountainparkumc.org/mppreschool
Should be Empty:

Camper Information

Medical Information

Parent/Guardian Details

Emergency Contact Details

Payment Details

Acknowledgment, Authorization, and Waiver