Grace Church of Mentor Grace Bible Day Camp

GRACE BIBLE DAY CAMP 2011


Please fill out the information below for your child(ren) attending. A credit card payment is required in order to submit a registration online. This form must be submitted by the parent or legal guardian authorized to consent for transportation and medical concerns. By submitting the information below, you are electronically signing the registration and consents.

* = Required

Parent/Guardian Information

*First: *Last:
*Home Phone:Cell Phone:
*Address: *City:
*Email: Home Church:

Emergency Contact
*First: *Last:
*Relationship: *Phone:

Transportation Agreement
Grace Bible Day Camp transports its campers from Grace Church of Mentor to a local park for lunch and activities. I hereby give my permission and assume full responsibility for my child(ren) to participate in GBDC including transportation to and pickup from the event and thereby release all workers of GBDC and Grace Church of Mentor from any liabilities whatsoever, and I understand that no insurance will be provided.
*Please Select:

Medical Consent
Consent for Medical Treatment
In the event that reasonable attempts to contact a parent or guardian have been made without success, I give my consent for the administration of treatment deemed necessary by a licensed physician or dentist and the transfer of the child(ren) to any reasonably accessible hospital.
Refusal of Consent for Medical Treatment
I do not give my consent for emergency medical treatment of my child/children. In the event of an emergency I wish GBDC to take no action or to [optional field Medical Treatment Consent Other (see below)]
*Please Select:

Child(ren) Attending
*First: *Last:
*Birthday:
*Age/Grade Completed: *Gender:
Medical Concerns:
Food allergies:
Place this child with (Note the child must be in the same age group):
Additional Comments:
 
*First: *Last:
*Birthday:
*Age/Grade Completed: *Gender:
Medical Concerns:
Food allergies:
Place this child with (Note the child must be in the same age group):
Additional Comments:
 
*First: *Last:
*Birthday:
*Age/Grade Completed: *Gender:
Medical Concerns:
Food allergies:
Place this child with (Note the child must be in the same age group):
Additional Comments:
 
*First: *Last:
*Birthday:
*Age/Grade Completed: *Gender:
Medical Concerns:
Food allergies:
Place this child with (Note the child must be in the same age group):
Additional Comments:
 
*First: *Last:
*Birthday:
*Age/Grade Completed: *Gender:
Medical Concerns:
Food allergies:
Place this child with (Note the child must be in the same age group):
Additional Comments:
Total Due: