Registration and Release Form-St. Luke’s Episcopal Church Music & Arts Camp 2025 
This form should be completed by the parent/guardian of all participants in "Music and Arts Camp 2025"
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Email *
Parent or Guardian’s Name(s) *
Home Address *
Parent or Guardian Phone Number(s) *
Additional Emergency Contact Information (Name, Relationship, Phone) *
Child # 1 Full Name (“Participant”) *
Child # 1, date of birth *
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Child #1 grade level for 25/26 school year *
Child #1 t-shirt size *
Child # 2 Full Name (“Participant”)
Child #2, date of birth
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DD
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YYYY
Child #2 grade level for 25/26 school year
Child #2 t-shirt size
Clear selection
Child #3 Full Name (“Participant”)
Child #3, date of birth
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DD
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YYYY
Child #3 grade level for 25/26 school year
Child #3 t-shirt size
Clear selection
My child(dren) will eat the provided lunch Monday-Friday *
Required
Please list any dietary restrictions or food allergies. We will do our best to accomodate dietary restrictions, and will be in contact with families if we have any questions.
Please list any additional allergies or medical information for your children.
Please list any behavioral or developmental situations the staff and adult volunteers should be made aware of.
In addition to the Parent/Guardian listed above, I give permission for the following people to transport my child from the St. Luke’s campus:
LIABILITY RELEASE: In consideration of St. Luke’s Episcopal Church allowing the Participant to participate in youth ministry activities, we (I), the undersigned, do hereby release, forever discharge and agree to hold harmless St. Luke’s Episcopal Church, its employees, volunteers and agents from any and all liability, claims or demands for accidental personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the Participant while involved in the youth activities. We (I) the parent (s) or legal guardian (s) of this Participant hereby grant our (my) permission for the Participant to participate fully in youth ministry activities. Furthermore, we (I) [and on behalf of our (my) Participant(s)] hereby assume all risk of accidental personal injury, sickness, death, damage and expense as a result of participation in recreation and work activities involved therein. The undersigned further hereby agree to hold harmless and indemnify St. Luke’s for any liability sustained by St. Luke’s as the result of the negligent, willful or intentional acts of said Participant, including expenses incurred attendant thereto.   (Please sign electronically and date below) *
Medical Treatment Permission: We (I) authorize an adult, in whose care the minor has been entrusted, to consent to any emergency x-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital or emergency care facility. The undersigned shall be liable and agree (s) to pay all cost and expenses incurred in connection with such medical and dental services rendered to the afore mentioned youth pursuant to this authorization. (Please sign electronically and date below.) *
Photo & Video Release Permission: Photographs  may be taken during activities for archival and promotional purposes. I give permission for images which include my child’s likeness to be used for these materials (newsletter, web page, social media, etc.) in highlighting events or activities which represent St. Luke's. NAMES WILL NOT BE USED. *
Required
Camp fee is $100 for first child and $75 for each additional child from the same household. This INCLUDES lunch for each day and all supplies. How will you be submitting your payment? 

(Full or partial scholarships are available on an honor system for anyone that requests one. Please email rblack@SLS.church if you will be using our scholarship fund so we can mark you as 'paid'.)
 *
Required
A copy of your responses will be emailed to the address you provided.
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