MAD CAMP Registration - June 19-23, 2017 - Collingwood Presbyterian Church
Register for the MAD (Music Art Drama) CAMP at Collingwood Presbyterian Church!

WHO: Children entering into 1st-6th grades
WHERE:  Collingwood Presbyterian Church, 2108 Collingwood Blvd., Toledo, OH 43620, ph: 419-243-3275
WHEN: Monday - Friday 9am-12:30pm & Friday 7pm - Bravo! Showcase
$25 per child, or $50 per family (up to 4 kids)
WHAT: Kids get to experience a week of exciting workshops on a variety of different creative arts including:
Choir, hand bells, chalk drawing, clay sculpting, sign language, fun with food, and other visual arts

Contact Information
Name of parent/guardian:
last name, first
Your answer
Street address:
Your answer
City:
Your answer
State:
Your answer
Zip:
Your answer
Home telephone:
Your answer
Parent/caregiver’s cell phone
Your answer
Home e-mail address:
Your answer
Emergency contact other than parent/guardian:
Your answer
Emergency contact - Phone:
Your answer
Emergency contact - Relationship to child:
Your answer
#1 Camper - Child’s name:
last name, first name
Your answer
#1 Camper - Child’s age (years):
Your answer
#1 Camper - Date of birth:
dd/mm/year
Your answer
#1 Camper - Last school grade completed by June 19, 2016:
Your answer
#1 Camper - Allergies or other medical conditions:
Your answer
Please choose a class for each of the three sessions:
Session #1
Session #2
Session #3
Other info:
May we have your permission to use photograph/video of your child(ren) for promotional purposes?
Note: if you do not give permission, your child will be pulled out of activities when photos are being taken. Please explain this to your child before camp starts so they understand and to avoid any complications. Thank you!
By submitting this form the parent/guardian of the above listed child agrees to the following:
Required
Any other questions, comments, or concerns?
Your answer
Parent / Guardian Signature
Please type in your initials and email address to give permission and agree to terms.
Your answer
Date
Your answer
Submit
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