2024 Day Camp Registration Form

Parent/Guardian Name*

First NameLast Name

Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number:*

Area CodePhone Number

E-mail:*

example@example.com

How many children would you like to register?

You can register up to 5 children using this form. To register more than 5, please call 613-258-4815 x 100

Child's Name:*

First NameLast Name

2nd Child's Name:*

First NameLast Name

3rd Child's Name:*

First NameLast Name

4th Child's Name:*

First NameLast Name

5th Child's Name:*

First NameLast Name

Date of Birth*

2nd Child's Date of Birth*

3rd Child's Date of Birth*

4th Child's Date of Birth*

5th Child's Date of Birth*

Child's Grade in Sept 2024*

2nd Child's Grade in Sept 2024*

3rd Child's Grade in Sept 2024*

4th Child's Grade in Sept 2024*

5th Child's Grade in Sept 2024*

Health Card #:

2nd Child's Health Card #:

3rd Child's Health Card #:

4th Child's Health Card #:

5th Child's Health Card #:

Weather permitting we will be playing some games and activities outside in the sun. In order to keep everyone from getting sunburned, we suggest hats and request that all campers wear sunscreen.

To make it easier for families and the camp staff to make sure that everyone has sunscreen, the Church can provide a high SPF sunscreen (50+) for your child(ren) for the duration of the The Shepherd King Kids Camp.

Sunscreen Authorization

YesNo

2nd Child - Sunscreen Authorization

YesNo

3rd Child - Sunscreen Authorization

YesNo

4th Child - Sunscreen Authorization

YesNo

5th Child - Sunscreen Authorization

YesNo

In case of emergency please contact:*

Please include an alternate phone number or cell phone number.

Allergies or Medical Conditions:*

Family Doctor:

Other information that you would like us to know:

Media Release:

I allow North Grenville Community Church permission to take photos, videos and other media of my child(ren), during The Shepherd King Day Camp. I understand that this media may be stored and used for promotion of North Grenville Community Church, its ministries or of future events or programs and/or shared online or via social media. If I have questions, I understand that I can contact the Church office at 613-258-4815 x 100.

Waiver:

I hereby give permission for my child(ren) to participate in The Shepherd King Day Camp. I furthermore assume absolute responsibility and liability for such activities and, we agree to indemnify and save harmless the Free Methodist Church of Canada, North Grenville Community Church or any of their officers, members or adherents, representatives, agents, consultants and independent service providers from any and all liability for any and all actions, losses, damages and expenses (including, without limitation, the loss, damage or theft of money or property), personal injuries, or deaths, however, caused. I also understand that in the event of a medical emergency the adult supervisors have my permission to use their best judgement to authorize emergency medical procedures.

Acknowledgement:

By submitting this form, I, {parentguardianName}, acknowledge that I have read the above media release and waiver and agree to its terms.

Enter the message as it's shown*