Please fill out the form below completely to Register for Project Sercret Service 2007 Summer Day Camp.
You will be sent a release form and envelope for payment in the mail.
Child's Name (children):
Gender: Female
Birthdate: Age: ---- Grade (Fall 2007):
Does child attend Church? Yes No ---- If Yes, where:
Names of siblings attending:  
Parent's Names:
Address:  
City, State, Zip:
Phone #s: Home: ----Work: ----Cell: ----Email:
Emergency Contact:  Relationship:
(Other than above)
Phone:   

Is your child (children) covered by medical/hospital insurance? Yes No
If Yes, what is the carrier plan or name:

Allergy/Health Conditions:   

Current Medications or Restrictions (please explain any activity
restrictions or limitations and necessary adaptations):
This information is correct and complete as far as I know. My Child (name listed above), has my permission to attend and participate in First Baptist Church's Summer Day Camp, August 6 - 10, 2007 and to engage in all activities except as noted. I hereby give permission to the day camp staff to provide routine health care and administer prescribed medications. In the even that I cannot be reached in an emergency, I hereby give permission to the day camp staff to seek emergency medical treatment for my child. (Actual signature will be taken opening day of the camp)
Yes
Date:    ---- Are you interested in AfterCare? What is your need/preference?