Kids Day Camp

*All fields are required

Name of Parent/Guardian

Email of Parent/Guardian

Child's Name

Child's Age

Address

Contact Number

Allergies

Medicare Card Number

I hereby give permission to my son/daughter(s) to attend the Peoples Church Summer Day Camp from July 24 to July 27, 2012. I do release Peoples Church and the leadership team from any liability for injury to or damage done by my son/daughter(s). (Within a reasonable amount of care) I authorize medical treatment if necessary.

Cost is $15.00 per child.