*June 26-30, 2017; 9 AM-12 PM *For Ages 3 years (totally toilet-trained) through 5th grade *$35 for the week, covers T-shirt & CD *After care 12-2 PM; $10 per day, per child *Family Supper & Ice Cream Social on Thursday, June 29; 6:30-8 PM Register by June 5th You canpay online or when you drop your children off at camp. Payment must be made at drop off, not pick-up. If you have more than one child attending, please fill out one form per child and return this form to the church office or email Elyse Milligan at firstname.lastname@example.org.
Date of birth: ____________________________________________ Age: _______ Last grade completed: _________ Camper’s T-shirt size: (please circle) S M L Address: ____________________________________________________
Zip Code: _____________________________
Your email: ___________________________________________
Emergency Contact Name (In event we can’t reach mom or dad): ________________________________
Emergency Contact Phone Number: __________________________
Will your child need aftercare? (please circle) ($10 per day, per child) Yes No Would you be interested in volunteering for VBS? (please circle) Yes No
If so, what area? ____________________________________
Policy Number:______________________________________ Group #_________________
I hereby give permission to the Physician selected by the adult in charge of the East Lake United Methodist Church/Children’s Activity to order X-Rays, routine tests and treatment for the health of my child, and in the event that I cannot be reached in an emergency, I hereby give permission to the Physician selected by the adult in charge to hospitalize, secure proper treatment for, and to order injections and/or anesthesia and/or surgery for my child as named above.
Parent or Guardian Signature ____________________________________Date:__________
Photo Video Release I, as the parent/guardian of ____________________________, herby consent that any photographs or videotape taken while my son/daughter attends East Lake United Methodist Church, or any events associated with East Lake UMC, may be used for print publications, website, and/or videos, to be used within the church and/or to promote the church and its ministries.