Summer Fun Days Registration Form

A Brief Description of the Activities

June 10th Circus Fun
at YMCA
400 E. Calhoun St.
Macomb, IL

1:30 - 4:00pm
Chlidren completed grades 1st-5th

July 22nd Let's Get Messy
at Vince Grady Field at WIU
University Drive
Macomb, IL

1:30 - 4:00pm
Bring towel and clothes that can get messy!
Children completed grades 1st-5th

August 12th Summer Splash Down
at Macomb Country Club Pool
20 Hickory Grove
Macomb, IL
(309) 837-1909

6:30 - 9:00pm
Free Swim, Snacks, Live music, light dinner
Youth completed grades 6th-8th

Events Attending*

June 10th Circus Fun (1:30 - 4:00pm)July 22nd Let's Get Messy (1:30 - 4:00pm)August 12th Summer Splash Down (6:30 - 9:00pm)

If you would like your child to participate in this event, please complete and submit the following statement of consent and release of liability. As a parent or legal guardian, you remain fully responsible for the actions and conduct of your child, including any legal responsibility which may result.

I hereby consent to participation by my child (insert child's name)*

First NameLast Name

in this activity. I understand that this event will take place away from the church facilities and that my child will be under the supervision of designated leaders. I further consent to the conditions stated above regarding participation in this event. In consideration of my child's being allowed to participate in this field trip, I agree to indemnify and hold harmless First Christian Church of Macomb and First Presbyterian Church of Macomb and its representatives, including chaperones, from any and all claims, including negligence, arising from or relating to my child's participation in this event. This indemnification and hold-harmless agreement does not apply to claims for intentional misconduct or gross negligence.

I as parent or legal guardian (insert your name)

First NameLast Name

agree to the above conditions.

AgreeDisagree

Summer Fun Days Parent Permission Form