Summer Camp Registration Form

Dates: July 28–July 31
Location: Grace Church

445 Stevenson Road North, Oshawa, Ontario

Time of drop-off: 9 am

Time of pick-up: 3 pm

Your Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

STUDENT INFORMATION

Name

First NameLast Name

Age

Gender

Grade completed

Have you previously attended kids camp at Grace Church?

Home Church (if any)

Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

EMERGENCY CONTACTS
Please list the first and last names and phone numbers off ALL adults, in addition to the one filling out this form, who are allowed to pick up this child. The child will only be released to these people.

Primary Guardian

First NameLast Name

Relationship to child

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Alternate Guardian #1

First NameLast Name

Relationship to child

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

MEDICAL INFORMATION

Please list all allergies -- or type "none" if there are none

Does your child carry an epi-pen? (please note: if yes, it is the responsibilty of the child's guardian to ensure the child has the epi-pen at every drop off and pick up)

Please list all medical concerns -- or type "none" if there are none

ADDITIONAL INFORMATION

What is your child's t-shirt size

Please specify

Lunch and a light breakfast will be provided at camp. Please list any dietary restrictions we should be aware of -- or type "none" if there are none

Do you have any questions, concerns, or special requests related to the camp program that you would like our staff to be aware of?

Camp photos/videos are taken for promotional purposes related to Grace Church. These pictures appear in various media outlets such as our social media and webpage.

I authorize staff or volunteers to photograph/record my child for these purposes.

Liability Waiver & Consent

I, the undersigned parent/guardian, give permission for my child to participate in the kids camp program. I understand that reasonable precautions will be taken for the safety of all participants; however, I release and hold harmless Grace Church, its staff, and volunteers from any liability in the event of accident or injury.

I authorize staff or volunteers to seek medical treatment for my child in case of emergency if I cannot be reached.

By signing and submitting this form, I ackowledge I have read and understand the above information.

Signature

Summer Kids Camp Registration