Music Camp Form

2008 Music Camp Registration

Child's Name:

Please check the camp you are registering for?Angel, June 2-6, Rising Kindergarten thru rising 2nd Grade
Junior, June 23-27, Rising 3rd Grade thru rising 6th Grade

Address:

Age:

Grade Entering:

Parent/Guardian:

Home Phone:

Work Phone:

Cell Phone:

Email:

Emergency Contact:

Are there any medical conditions or allergies we need to be aware of?

Doctor's Name and Phone Number:

Parent/Guardian: As the legal guardian of the child named above, do you give permission for the named child to participate in the above named activity? Do you understand that in the event of an emergency that the leaders will do everything in their power to contact you personally, but in the event that they are unable to do so, you are giving your permission for the leaders to seek necessary medical attention for the child named above?YesNo

Parent/Guardian: Do you give permission to PSFUMC to use your child's photograph in its official printed publications (including local newspapers) without further consideration, and do you acknowledge PSFUMC's right to edit the photograph at its discretion either now or at another time? I agree to indemnify and hold harmless PSFUMC from any claims.YesNo

Registration will be complete after payment of $15 is received. Please make check payable to PSFUMC/MUSIC CAMP and mail to 4329 Marietta Street.I will mail payment.

Please contact the Church Office at 770.943.5130 if you do not receive an email confirmation within 24 hours.