Vacation Bible Summer Camp 2017 Registration Join us at Walton United Church for a week of summer fun! Open to children entering SK-Grade 6 in the fall of 2017

Dates:

Monday, July 10 - Friday, July 14, 2017

Time:

8:30 am – 12:00 pm □

*Before / Aftercare: 8:00 am – 8:30 am **Cost: $40.00 / week for half day

□

OR

8:30 am – 4:30 pm □

AND / OR 4:30 pm – 5:00 pm □

$80.00 / week for full day

*Extended hours aftercare can be available at additional cost. Please contact Alison King at [email protected] for details. ** Confidential fee assistance is available by contacting Rev. Gill, Val Waldron or Alison King Personal Information: Child’s Name: ________________________________________________ Birth date: _________________________________ Entering grade _____ in September 2017 Parent #1 Name: __________________________________________________________ Parent #2 Name: ___________________________________________________________ Address (including city and postal code): ___________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________ Phone #1: _____________________________________________

Phone #2

:_____________________________________________

Email Address: ___________________________________________________________________________________________________________________ Emergency Contact (name and phone number), in the event a Parent/Guardian cannot be reached: ___________________________________________________________________________________________________________________________________

Medical Information: Doctor’s Name: ________________________________________________ Doctor’s Phone Number: ________________________________________ Doctor’s Address (including city and postal code): ___________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________ Allergies, Medical or Learning Concerns: ___________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________

Conditions of Enrollment: 1. 2.

3. 4. 5. 6. 7. 8.

9.

The VBSC Director reserves the right to dismiss a camper who in his/her opinion is a hazard to the safety and the rights of others. Every precaution is taken for the safety and good health of the participants, but in the event of accident or sickness, Walton United Church, including the Camp Directors, staff and volunteers, are hereby released from liability. Each participant must be covered by Provincial Health Insurance or the equivalent. In the event that a participant requires special medical attention (i.e. medication, x-ray) the parents will be notified immediately. By signing this form, you grant permission to Walton United church to contact you by mail, phone and email. Children entering Grade 6, 7 and 8 have the option of working as a Junior Counsellor for the week, assisting with crafts, games, activities, organization and clean up. Cost is 50% of regular fees. Students in high school and above are welcomed as volunteer counsellors (qualifies for volunteer hours). Please contact [email protected] for more information. □ By checking this box, I give Walton United Church permission to take pictures to be used for internal church purposes only. □ By checking this box, I give Walton United Church permission to post my child’s pictures onto the Walton Memorial United Church Facebook page, understanding that once a picture has been posted, that picture becomes the property of Facebook. □ By checking this box, I give permission for my child to join the camp staff, volunteers and campers, on walks around the neighborhood.

I give my child, _____________________________________, permission to attend Vacation Bible Summer Camp at Walton Memorial United Church, and participate in the activities of the program, from Monday, July 10 to Friday, July 14, 2017.

Name of Parent/Guardian (printed): ____________________________________________________ Signature of Parent/Guardian: __________________________________________________________ Date:

Please submit the completed registration form and appropriate fee to the church office. Confidential fee assistance is available by contacting Rev. Gill, Val Waldron or Alison King.

Walton Memorial United Church Phone: 905-827-1643 Email: [email protected]

For office use only: ____ Paid