Registration for Spring Break Day Camp

PLEASE READ: You MUST agree to the Legal Waiver Release for EACH CHILD in this form. If you do not complete this step for each child on this form, you will be required to fill out a paper version form upon arrival at day camps.
Parent Information
Primary Parent/guardian *
Primary Parent/guardian
Second Parent/guardian
Second Parent/guardian
Emergency Contact Information - This contact will be used if we cannot reach the primary parent.
Emergency Contact *
Emergency Contact
Child Information #1
Child's Name *
Child's Name
Child's Birthday *
Child's Birthday
Please select below to grant permission for the reasonable use of pictures containing your child in any or all of the following ways: *
Legal Waiver Release - CHILD #1 *
I/we, the parents/gaurdians named above, authorize Peoples Church Ministry Staff to sign consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment, or procedures for the participant named under child #1. I/we understand that every effort will be made to contact the appropriate parent/legal guardian or emergency contact in the event of an emergency. I/we, undertake and agree to indemnify and hold blameless Peoples Church, its Pastors, Board of Directors, Ministry Staff, and Volunteers from and against any loss, damage, or injury suffered by the participant as a result of being part of the activities of Peoples Church, as well as any medical treatment authorized by the supervising individuals representing the church. This consent and authoization is effective only when participation in or travelling to events of Peoples Church. Peoples Church is collecting and retaining this personal information for the purpose of enrolling your child in our programs, to assign the student to the appropriate classes, to develop and nurture ongoing relationships with you and your child, and to inform you of program updates and upcoming opportunities at our church. This information will be maintained indefinitely as it is a requirement of our insurance company and legal counsel. If you wish Peoples Church to limit the information collected, or to view your child's information, please contact us.
Child Information #2 (if applicable)
Child's Name
Child's Name
Child's Birthday
Child's Birthday
Please select below to grant permission for the reasonable use of pictures containing your child in any or all of the following ways:
Legal Waiver Release - CHILD #2 (REQUIRED)
I/we, the parents/gaurdians named above, authorize Peoples Church Ministry Staff to sign consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment, or procedures for the participant named under child #1. I/we understand that every effort will be made to contact the appropriate parent/legal guardian or emergency contact in the event of an emergency. I/we, undertake and agree to indemnify and hold blameless Peoples Church, its Pastors, Board of Directors, Ministry Staff, and Volunteers from and against any loss, damage, or injury suffered by the participant as a result of being part of the activities of Peoples Church, as well as any medical treatment authorized by the supervising individuals representing the church. This consent and authoization is effective only when participation in or travelling to events of Peoples Church. Peoples Church is collecting and retaining this personal information for the purpose of enrolling your child in our programs, to assign the student to the appropriate classes, to develop and nurture ongoing relationships with you and your child, and to inform you of program updates and upcoming opportunities at our church. This information will be maintained indefinitely as it is a requirement of our insurance company and legal counsel. If you wish Peoples Church to limit the information collected, or to view your child's information, please contact us.
Child Information #3 (if applicable)
Child's Name
Child's Name
Child's Birthday
Child's Birthday
Please select below to grant permission for the reasonable use of pictures containing your child in any or all of the following ways:
Legal Waiver Release - CHILD #3 (REQUIRED)
I/we, the parents/gaurdians named above, authorize Peoples Church Ministry Staff to sign consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment, or procedures for the participant named under child #1. I/we understand that every effort will be made to contact the appropriate parent/legal guardian or emergency contact in the event of an emergency. I/we, undertake and agree to indemnify and hold blameless Peoples Church, its Pastors, Board of Directors, Ministry Staff, and Volunteers from and against any loss, damage, or injury suffered by the participant as a result of being part of the activities of Peoples Church, as well as any medical treatment authorized by the supervising individuals representing the church. This consent and authoization is effective only when participation in or travelling to events of Peoples Church. Peoples Church is collecting and retaining this personal information for the purpose of enrolling your child in our programs, to assign the student to the appropriate classes, to develop and nurture ongoing relationships with you and your child, and to inform you of program updates and upcoming opportunities at our church. This information will be maintained indefinitely as it is a requirement of our insurance company and legal counsel. If you wish Peoples Church to limit the information collected, or to view your child's information, please contact us.
Child Information #4 (if applicable)
Child's Name
Child's Name
Child's Birthday
Child's Birthday
Please select below to grant permission for the reasonable use of pictures containing your child in any or all of the following ways:
Legal Waiver Release - CHILD #4 (REQUIRED)
I/we, the parents/gaurdians named above, authorize Peoples Church Ministry Staff to sign consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment, or procedures for the participant named under child #1. I/we understand that every effort will be made to contact the appropriate parent/legal guardian or emergency contact in the event of an emergency. I/we, undertake and agree to indemnify and hold blameless Peoples Church, its Pastors, Board of Directors, Ministry Staff, and Volunteers from and against any loss, damage, or injury suffered by the participant as a result of being part of the activities of Peoples Church, as well as any medical treatment authorized by the supervising individuals representing the church. This consent and authoization is effective only when participation in or travelling to events of Peoples Church. Peoples Church is collecting and retaining this personal information for the purpose of enrolling your child in our programs, to assign the student to the appropriate classes, to develop and nurture ongoing relationships with you and your child, and to inform you of program updates and upcoming opportunities at our church. This information will be maintained indefinitely as it is a requirement of our insurance company and legal counsel. If you wish Peoples Church to limit the information collected, or to view your child's information, please contact us.