PD Day Camp on Friday April 24, 2026

Parent/Guardian Information

Parent/Guardian Name

This address will receive a confirmation email

Phone

Secondary Emergency Contact - Name and Phone Number

Child Information

Child Name

Child's Grade

Second Child's Name

Second Child's Grade

Third Child's Name

Third Child's Grade

Fourth Child's Name

Fourth Child's Grade

Is there anything that we should know about your child's health (ie. medication, allergies, challenges)?

Total Cost

Total Cost:

PERMISSION

It is the commitment of Emmanuel Church and its staff and volunteers to provide a safe and healthy environment in which your children can both grow spiritually and have fun. We will take every precaution to ensure the safety of your children at all times.

By clicking "YES":

I confirm that I am the parent/legal guardian of the child(ren) registered above. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any illness or injury to my child(ren), including, but not limited to, personal injury, disability, death, damage, loss, claim, liability, or expense, of any kind, that my child(ren) may experience or incur in connection with my child(ren)’s attendance at the PD Day Camp at Emmanuel Evangelical Missionary Church.

On my behalf and on behalf of my child(ren), I hereby release, covenant not to sue, discharge, and hold harmless Emmanuel Evangelical Missionary Church, its directors, members, employees, volunteers, agents and representatives, of all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto.

I, the undersigned parent/guardian, authorize the administration of any necessary first aid or medical treatments, and in the case of a medical emergency, authorize permission for Emmanuel Evangelical Missionary Church and it's volunteers, or their designate, to hospitalize and secure proper treatment for the child(ren) named above. In the event of an emergency, every effort will be made to contact parents or guardians before such action.

I (Parent/Guardian named above) have read, understood, and agree to assume all risks as outlined above

Yes No

PD Day Camp on Friday April 24, 2026

It is the commitment of Emmanuel Church and its staff and volunteers to provide a safe and healthy environment in which your children can both grow spiritually and have fun. We will take every precaution to ensure the safety of your children at all times.

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