This form is for registering your child for Day Camp. If you are going to register more than one child, you will need to fill out the entire form for each child.
“CONSENT FOR MEDIA USE” This registration gives COG the authorization to use photos and videos of your child for promotional purposes including brochures, websites, and other forms of media.
Someone who can be contacted if the Parent/Guardian can not be reached.
Emergency Information (Insurance is not required but chruch is not liable for injuries)
Give approximate dates for any one that is applicable
Self-Administered Emergency Medication
(if needed) must be signed by Parent/Guardian AND Healthcare Provider
I will provide written permision signed by parent/guardian and healthcare provider that indicates that my registered child is permitted to have readily available (carry or possess outside of the regular supervision of the camp’s health staff) and self-administer the above medication as medically necessary and IS COMPETENT TO self-administer.
Authorization for Treatment:
This health history is correct so far as I know, and the person herein described has permission to engage in all camp activities. I hereby give permission for the camp nurse to administer prescribed medications, including non-prescription medications for mild illness, and to assess and administer treatment for my child as named above. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the camp director to secure and administer treatment, including hospitalization, and to order injections, anesthesia or surgery for my child as named above.
PARENT SIGNATURE REQUIRED
My name added to the box below is the legal equivalent of my signature.
The cost per child to attend Day Camp is $40. If you are unable to pay or prefer to pay by check or in cash then select $0 from the dropdown box. You will then be able to pay on the first day your child attends camp. If you are unable to afford the price, please fill out the registration form anyway. We would hate to see any child miss out on Day Camp due to lack of funds.
