Created to Create Registration Page - Calvert Grace Community Church

Created to Create Arts Camp

Cost is $30 for one child or $25 each for more than one child.

Parent Name(Required)

First Last

Email(Required)

Phone

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Photograph Consent

I give my permission to have my child(ren) photographed.

Number of Children

More than 1

Child's Name

First Last

Grade (as of 2022-23 school year)(Required)

Cost for one child

Price:

Cost for more than one child

Price: $25.00

Total

Consent

Check here if you are interested in being a parent volunteer and someone will contact you.

Medical Release Portion

Child's Name

First Last

Child's Birthdate

Parent Email

Consent(Required)

I give permission for the adult leaders from Calvert Grace to seek medical treatment for my child. In the event of an emergency, I consent for my child to receive such medical treatment and/or surgical procedures deemed necessary by medical personnel. I hold harmless and fully and forever release and discharge Calvert Grace, all officers, agents and volunteers and or employees or staff of Calvert Grace from any and all claims, demands, rights of action, present or future, whether the same be known, anticipated or unanticipated, resulting from, or arising out of, or incident to, the providing of this medical assistance. I assume liability for any medical expenses involved. The insurance coverage (if any) that we carry will be the primary coverage for my child. I understand that every reasonable effort will be given to contact me as soon as possible should an emergency arise. Check box that you have read and agree.(Required)

Health Conditions

Allergies/Dietary Restrictions

Insurance Company, Group #, ID # Policy Holder's Employer

Emergency Contact Name, address, phone number

Write "same as above" if the emergency contact information is the same as the parent information.

Signature(Required)

By signing this document, I certify all of the above information is true and accurate. I agree to the stipulations above in the event of a need for medical treatment. I have legal custody of the child listed on this form. This release shall be in effect during the times that the above-named minor is in the care and custody of Calvert Grace Community Church and shall include but not be limited to transportation to and from activities sponsored by Calvert Grace.

Total

Credit Card

Card Details

Cardholder Name

Created to Create Arts Camp

Medical Release Portion

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