Children's Day Camp Registration

Please complete this form and submit it. - Thank you!

(Please only register Children at the same address together)

Enter information for up to 4 children in the same household

First Name:

Last Name:

Gender:

Childs Birthdate:

Choose Camp:

Child care required in: Morning Afternoon Both None

Street Address (include Apt#)---

City ---

Postal Code ---

Phone # ---

Alt Phone # ---

E-mail Address (if any) ---

Church Affiliation (if any)---

Medical Concerns or other Comments:

I, , authorize my child(ren) named above, to participate
in the activities and outings conducted by Collingwood Baptist Church Summer Day Camps.
In the event of an accident or sickness, Collingwood Baptist Church, its staff, and its
volunteers are hereby released from any liability. In the case of a medical emergency,
I give permission to secure treatment for my child. I authorize photographs to be taken
of my child and to be used for promotional materials for Collingwood Baptist Church.

Type "I Agree" in box above instead of Parent's/Guardian's Signature