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    Day Camp Registration Form 2013

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    api-123486123
    South Hope Community Church's Day Camp - Summer 2013. Please provide an emergency contact in case you cannot be reached. SHCC reserves the right to use your child's picture taken at Day Camp for advertising purposes.

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    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd

    Day Camp Registration Form 2013

    Uploaded by

    api-123486123
    48 views1 page
    South Hope Community Church's Day Camp - Summer 2013. Please provide an emergency contact in case you cannot be reached. SHCC reserves the right to use your child's picture taken at Day Camp for advertising purposes.

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    day camp registration form 2013

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    South Hope Community Church's Day Camp - Summer 2013. Please provide an emergency contact in case you cannot be reached. SHCC reserves the right to use your child's picture taken at Day Camp for advertising purposes.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    48 views1 page

    Day Camp Registration Form 2013

    Uploaded by

    api-123486123
    South Hope Community Church's Day Camp - Summer 2013. Please provide an emergency contact in case you cannot be reached. SHCC reserves the right to use your child's picture taken at Day Camp for advertising purposes.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    Registration Form - South Hope Community Churchs Day Camp - Summer 2013

    Name____________________________ Address_____________________________________ City__________________________ State________ Zip__________ Phone________________ Age____ Birth date_______ Entering grade____ Church_______________________________ Parent or Guardian________________________ Phone__________________ Please provide an emergency contact in case you cannot be reached. Emergency Contact_______________________ Phone_______________ SHCC reserves the right to use your childs picture taken at Day Camp for advertising purposes. Please check this box if you do not want your childs photo used.
    HEALTH HISTORY (giving approximate dates) 1. Please list all allergies and health concerns.

    Childs Name______________________
    In the event I cannot be reached in an EMERGENCY, I hereby give permission to the physician or hospital selected by the Camp Director to hospitalize, secure proper treatment for, and to order injection, anesthesia, or surgery for my child as named above.

    2. Is Your Child taking any medications? Yes No *If yes, please list.

    PARENT'S SIGNATURE*
    3. Is your child current on all immunizations? Yes No

    _____________________________________ Printed Name__________________________ Date______________


    *Required for those under 18; to be signed by parent or guardian in ink.

    4. Has your child been under a physicians care in the last 6 months? Yes No * If yes please explain

    Please return completed form to: South Hope Community Church 142 Main Street Hope, Maine 04847

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