Whole Armor Church Summer Camp Registration

Summer Camp Registration

Please complete one Registration Form per child you wish to register.
CHILD INFORMATION:
Child Name*

First NameLast Name
Age*
MaleFemale
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Primary Phone Number*

Area CodePhone Number
E-mail*
YesNo
YesNo
Health History

Please ensure we have the proper information to better serve your child!
If you, the parent/guardian, cannot be reached, in the case of an emergency, who do we contact? Please Type Name and Phone Number below.*

First NameLast Name
Phone Number*

Area CodePhone Number
Are there any conditions, diseases or allergies we should be aware of? If yes, please explain:
YesNo
YesNo
Is there any other health related information we should know about or activity restrictions we should provide during the week? (Please Identify the medications, if needed while at the Whole Armor Church Summer Camp, here.)
Any dietary needs that we should know about?
I, the undersigned, herby give permission for my son/daughter to practice in the Summer Camp Events, Activities, and Discussions. I authorize any adult representative of Whole Armor Church Of God In Christ is acting in a leadership role to consent to and authorize the administration and performance of all treatments that may be considered advisable or necessary in the judgement of attending physicians, in the event that the above named participants should be admitted to any hospital, or be in need of any medical treatment. I take full responsibility for all charges and fees related to the treatment. I understand that the care and safety of the participant will be primary in all planned activities and that all attempts will be made to contact parents/guardians prior to treatment if an emergency or accident should happen.*

Yes
Should be Empty:

Summer Camp Registration

CHILD INFORMATION:

PARENT/GUARDIAN INFORMATION:

Health History