Nanaimo Alliance Church Daycamp Registration

Get ready for two fun-filled days of songs,

games, crafts, activities and puppets!

DATES: March 19 & 20

TIME: 9am - 2:30pm

CHECK IN: 8:45-9am

AGES: 6-12

COST: FREE!

Which Day(s) Will Your Child(ren) Attend?*

Thursday, March 19Friday, March 20

Child's Full Name

First NameLast Name

Child's Age

Child's Full Name

First NameLast Name

Child's Age

If there are additional children to register, please enter their full name(s) and ages:

Additional Comments or Information About Child(ren):

Parent/Guardian Phone Number*

Please enter a valid phone number.

Parent/Guardian Email Address*

example@example.com

Emergency Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Alt. Phone Number

Permission & Authorization

I understand that my child will be participating in a variety of recreational activities, both on site and off site while they are
registered in camp, and give permission for them to participate.

I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Nanaimo Alliance Church and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In the event of an emergency, I authorize camp leaders to seek medical attention for my child, including calling an ambulance and/or emergency contact person(s), as listed on this form. I understand a copy of this form and the information included on it may be provided to medical personnel if necessary.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Date*

Date

Signature*