Summer Camp Enrollment Form

Sycamore Summer Camp Registration
Theme:
“Jesus Teaches Us.. Love, Serve, Share, Pray, Hope”

Date:
Monday July28 - Friday Aug 1

Time:
9:00 am to 1:00 pm

Special Performance by Campers:
Sunday, Aug 3rd at 11:00 am. Summer Day Camp Join Worship Service.
ディキャンプ合同礼拝　午前11時

Location:
Sycamore Congregational Church, UCC
1111 Navellier Street, El Cerrito, CA 94530
510-525-0727 / sycamoreoffice22@gmail.com

Registration:
$ 225.00/Camper ($175.00 for siblings)
(Registration fee waived for Counselors)

“Includes Lunch”

Payment Option:
Cash or Check

Activities:
Fun filled days of Bible stories, singing, crafts, small group activities, outdoor activities and more.

Ages:

Camper: 3 years to (entering) Grade 5 (3歳より５年生までを対象)
Jr Counselor: (Entering) Grade 6 – Grade 8 (6年生より中学生まで)
Sr Counselor: (Entering) Grade 9 & up (高校生以上)
CHILD INFORMATION:
Child Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade (Entering Grade )*
Name of School (optional)
T-Shirt Size*
Registered by July 1 will be guaranteed a T-shirt.
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
E-mail*
example@example.com
MEDICAL INFORMATION
Physician Name

First NameLast Name
Phone Number
Medical Concerns (Please note and explain any condition(s) that may require special care, medication, allergy or dietary restrictions:
PARENT/GUARDIAN AUTHORIZATION
(Required for all children & youth under 18 years of age)
Sycamore likes to take photos and videos of camp participation, usually in groups, and to share them in publications and online posts.Names of individual children are never included. Do you grant this permission?

YesNo
Child Name

First NameLast Name
Parent/Guardian Name

First NameLast Name
Date

MonthDayYear
Date
Should be Empty:

Sycamore Summer Camp Registration

CHILD INFORMATION:

PARENT/GUARDIAN INFORMATION:

MEDICAL INFORMATION