2024 Summer Day Camp Registration
August 12-16, 2024 9:00am-3:30pm
Child's Information
Child's Name
*
First Name
Last Name
Child's Age
*
Age at time of camp
Child's Grade
*
Please Select
JK
SK
Grade 1
Grade 2
Grade 3
Grade 4
Grade your child is currently in.
Parent/Guardian Information
Parent/Guardian Name
*
Prefix
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
E-mail
*
example@example.com
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Who other than you is authorized to pick up your child?
Please provide their name and phone number.
Health Information
Does your child have allergies?
*
Please Select
No
Yes
Yes - with Epipen
Allergies
We will be providing morning and afternoon snacks, please inform us of any allergies your child has.
Please list any medical conditions we should know about in order for your child to participate.
Release of Information and Consent
Participation
*
I hereby give consent for my child to participate in the All Saints Kingsway Anglican Church Summer Day Camp program and all activities unless I advise in writing. (Please note: separate consent forms will be sent for any off-site trips, such as walking to the park, swimming, etc.)
Photographs
I give permission for All Saints Kingsway Anglican Church to take photographs which shall be used solely by All Saints for use on its website, social media, church bulletins/newsletters, and not for any commercial purpose.
Health
*
To the best of my knowledge, my child is in good health and I will notify All Saints Kingsway Anglican Church if he/she is exposed to any infectious disease.
Release
*
I release and agree to hold harmless All Saints Kingsway Anglican Church and its officers, employees, volunteers or agents from any liability concerning my child’s involvement in the All Saints Kingsway Summer Day Camp programs. I agree that the use of All Saints Kingsway Anglican Church facilities is done so at the risk of the registrant. In case of emergency, an All Saints Kingsway Day Camp Director or Adult Volunteer shall arrange to secure proper treatment and/or hospitalization for the child, as named on this form. Every effort will be made to contact a parent/guardian/emergency contact in the case of emergency. I understand that the All Saints Kingsway Day Camp Director reserves the right to dismiss a child who, in their opinion, is a hazard to the safety or rights of others, or who appears to have rejected the reasonable expectations of All Saints Kingsway.
Contact
I give permission for All Saints Kingsway Anglican Church to contact me periodically by email about upcoming events for my child/family. I can unsubscribe at any time.
Registration Date
*
-
Month
-
Day
Year
Date
Parent/Guardian Signature
*
By typing my name in the "Signature" field above, I am signing this document electronically. I agree that my electronic signature is the legal equivalent of my manual/handwritten signature on this document.
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