Name of Parent(s)

Cost:$40.00 ($80 max per family)

If child cannot pay, Please check box

Name of Student

Address

Phone No(s)

Grade

Important Info Concerning Child

Signed

Date

Signed

Date

Summer Day Camp
Registration Form
For Kids Entering Pre-K thru 5th Grade

Every Monday thru Friday
June 12th Thru July 28th     

10:00 a.m. to 3:00 p.m.

At: First Baptist Church, 310 W. Madison St. Girard

The undersigned gives permission to his or her child to participate in the above named activity and releases First Baptist Church, Girard, IL, its officers, employees, and agents from any liability whatsoever for any injury or death to person or loss or damage to property sustained by the undersigned for any member of his family, in attendance, and the undersigned agrees to defend and indemnify First Baptist Church, its officers, employees, and agents from any liability or loss they might sustain by reason thereof.  In the event I cannot be reached in an EMERGENCY, I hereby give permission to the physician selected by the children's ministry staff to hospitalize, secure proper treatment for, and order injection, anesthesia, or surgery for my child as named above.  I hereby give permission for my child to be transported to and from the above named activity with volunteers from First Baptist Church.

I release any photos taken of my child during this activity as property of First Baptist Church, Girard, IL with the knowledge that photos may be used in future publications as deemed appropriate.  This will include photos printed on websites associated with First Baptist Church.

If you prefer you may print the form and mail to:
First Baptist Church
310 W. Madison St.
Girard, IL 62640