Summer Day Camp Registration 2019

Child’s Name (required)

Parent’s Name (required)


Your Email (required)

Phone Number (required)

Child’s Age (required)

Child Grade Completed (required)

Allergies (if any)

Medical Information (list any information we should be made aware of)

Emergency Contact (required)

Emergency Phone Number (required)

Any additional information you would like to provide

Medical and Photographic Release
[I, the undersigned parent/guardian, of the above named minor, understand that in the event that medical treatment is required, every effort will be made to contact me. However, if I or my alternate contact person cannot be reached, I authorize the Wainwright Church of the Nazarene to seek medical treatment for my child as necessary. I also hereby grant permission to the Wainwright Church of the Nazarene to use photographic images and video footage of my child for various purposes such as printed materials, power point presentations, video productions, displays, Wainwright Church of the Nazarene website, etc…]

Check if you agree to these terms