Parkdale Summer Camp VBS Registration 2024

Parkdale Children Summer Camp

Registration Form

Name of Camper

Name of camperLast Name

Email of Parent/ Guardian

example@example.com

Name of Parent/ Guarian

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

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

Medical or developmental Concerns: please tell us more about your child:

Allergies:

Emergency contact name and phone number and relationship to camper

Format: (000) 000-0000.

Name of person(s) to pick up the child:

Name

Phone

Format: (000) 000-0000.

Name

Phone

Format: (000) 000-0000.

Name

Phone

Format: (000) 000-0000.

Names of other siblings enrolled in the camp

I, the undersigned parent/guardian, do hereby grant permission for my child, named above, to attend Summer Camp, a ministry of Parkdale United Church. In order that my child may receive the proper medical treatment in the event that my child may sustain injury or illness during Summer Camp, I hereby authorize the staff to obtain or provide medical treatment for my child for such injury or illness during the camp, and I hereby hold the staff and Parkdale Church, as well as its representatives, harmless in the exercise of this authority. I further understand that there is always a possibility that my child may sustain physical illness or injury while at the camp. If this occurs, I hereby authorize the staff to refer my child to a medical treatment center (hospital, etc I further acknowledge and understand that I will be responsible for any medical bills that may be incurred on behalf of my child for physical illness or injury that my child may sustain during the camp. Understanding that there is always a possibility that my child may sustain physical illness or injury, I acknowledge and understand that my child is assuming the risk of such physical illness or injury by participation, and I further release Summer Camp, Parkdale Church and its staff from any claims for personal illness or injury that my child may sustain during the camp. I further acknowledge and understand that my child will be responsible for his/her failure to abide by the rules and regulations of the camp.

signiture: yes, I approve

Please initial below to grant permission for the reasonable use of pictures containing your child in any or all of the following ways, brochures/promotional material, website, church, newsletters.

Yes

No

-Purpose and Extent Parkdale United Church is collecting and retaining this personal information for the purpose of enrolling your child in our programs, to assign the student to the appropriate classes, to develop and nurture ongoing relationships with you and your child, and to inform you of program updates and upcoming opportunities at our Church. The collection of this information is also a requirement of our insurance company and legal counsel.

I understand.

Parent Guardian Signature

Date

Thank you for registering your child in Parkdale Summer Children Camp.

CONSENT: