Stepping Stones March Camp 2025

First Congregational Church in Winchester

21 Church Street Winchester MA 01890

(781)729-9180

No School? Say Yes to Fun! At Stepping Stones Day Camp, kids will have fun, connect with old friends, and make ones while enjoying Bible stories, art, games, and STEM explorations!

Date: Tuesday, March 4th 2025

Time: 9:00 AM - 12:00 PM

Location: First Congregational Church in Winchester

Ages: Children Grades K-5

Cost: Free

We are thrilled to offer camp as a free activity to families but please consider making a one-time donation that fits your budget to offset the cost of materials and activities. Give to camp here.

Questions? Ask Maggie or check out the camp webpage

Child's Name:*

First NameLast Name

Child's Preferred Name: (if different)

Child's Gender:*

Child's Date of Birth:*

Date

Child's Grade (Fall of 2024):*

Parent/Guardian Name:*

First NameLast Name

Parent/Guardian Email:*

example@example.com

Parent/Guardian Phone Number:*

Please enter a valid phone number.

Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact Name:*

First NameLast Name

Emergency Contact Relationship to Child:*

Emergency Contact Phone Number:*

Please enter a valid phone number.

Name & telephone number of child's primary care doctor:*

Health Insurance Company Name:*

Health Insurance Policy Number:*

Please list your child's allergies, physical limitations, and health concerns of which we should be aware:*

Does your child have an emergency epipen, inhaler or other medication they may need to take during camp?*

If your child has an emergency epi-pen, inhaler or medication they may need to take during camp, you must complete the Medication Release Form.

Please list your child's special learning needs of which we should be aware. Does your child need additional support during the school year to help them learn best?*

Please list any additional comments and information about your child that would be helpful for us to know about (fears, special instructions, problems, behaviors, etc.). *

WAIVER & PERMISSION TO PROVIDE A PHYSICIAN AND HOSPITAL TREATMENT

My child/youth name* has permission to attend the event described above.

I understand that every effort will be made to contact parents/guardians in the event of an emergency. In an emergency requiring medical care and treatment, I authorize any physician, hospital or other healthcare provider to give care to this minor. I also give permission for the transport of my child/youth to/from a doctor and/or hospital by a chaperone or ambulance.

I hereby agree to hold harmless the First Congregational Church in Winchester and its agents and employees from any claim for personal injury or loss of life or property arising from participation in this Event. While I understand that the First Congregational Church in Winchester will take every precaution for safety, I realize that accidents do sometimes happen. I hereby release First Congregational Church in Winchester, its staff and its volunteers from any liability should an accident occur.

Signature of Parent/Guardian*

Date*

Date

PUBLICITY PERMISSION

In order to share the good news of the ministries of the church, we sometimes take photos/videos of the children for use on bulletin boards, in our newsletter and on our website or social media. We do not include any identifying information (Name, address, etc.) about the child. Do you authorize the use and reproduction of your child's likeness by the church?*

YesNo

Parent/Guardian Signature*

CARPOOL / PICKUP PERMISSION

The following individual(s) have permission to pick up my child from camp.Children will not be released from camp to any person not listed on this form. You may add or delete from this list at anytime by submitting a written request to Maggie Keeler (maggie.fccw@gmail.com). PLEASE LIST THE NAME, RELATIONSHIP & PHONE NUMBER.*

How did you hear about First Congregational Church's Stepping Stones Day Camp?*