Summer Day Camp
Every Monday thru Thursday .......... June 21st to July 19th 10:00 AM to 3:00 PM ................................ AT: First Baptist Church, 310 W. Madison St., Girard
Name of Student *
Your answer
Address *
Your answer
Grade of Student *
Name of Parent(s) *
Your answer
Parent(s) Phone No(s)
Your answer
Cost: $35.00 per child; $50.00 max per family. If child cannot pay, check ASSIST below.
ASSISST
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.
Signed *
Your answer
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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.
Signed *
Your answer
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