2017 ART-is-IN Camp Participant Registration Form

Participant's Name *

First Name Last Name

Parent/Guardian's Name *

First Name Last Name

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail *

Home Phone

- Area Code Phone Number

Cell Phone

- Area Code Phone Number

Your participant is a: *

Male Female

Birth Date *

Month Day Year

Grade Entering *

T-Shirt Size (Camp T-Shirts will be distributed on Thursday Afternoon.) *

YS (6-8) YM (10-12) YL (14-16) AS AM AL AXL

We care very much for the success and safety of each participant within our children’s ministry. Does your child have an allergy, medical condition, learning difference, disability or any other special need of which our ministry team should be aware?:

Do you attend church? *

Yes No

If so, where?

May we have permission to photograph your child? *

Yes No

May we have permission to use your child's photograph for the purpose of promotion? *

Yes No

Please remember to send a lunch with your child each day. We do not have staff available to assist children with lunches that require special preparation (cutting, microwaving, etc…). Please provide a lunch that is “ready to eat” We also serve 2 snacks per day. If your child has special dietary needs, you may wish to send your own snacks.

Art-is-In Camp *

Art-is-In Camp $ 90.00

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

PLEASE READ CAREFULLY BEFORE SUBMITTING.

As the parent or legal guardian, I hereby give permission for my child to participate in the Temple Bapitist Church's ART-is-IN Camp. I understand that Temple Baptist Church is a nonprofit charitable institution, which is voluntarily presenting this program for my child, other participants, and the community. I also understand that the program has activities that can involve physical contact with other participants, the ground or equipment, and that there is a resulting risk of physical injury to my child.

I have explained these risks and benefits of participating in this program to my child and my child is in proper physical condition and has no existing injuries or conditions that could jeopardize his/her safety or health, or the safety or health of the other participants.

I therefore release and discharge all liability for any harm or injury suffered directly or indirectly as a result of my child's participation in the Temple Baptist Church's ART-is-IN Camp, whether or not resulting from negligence, and I agree not to sue Temple Baptist Church, its representatives, staff, or volunteers on any such claim. I also give permission for the staff, representative, or volunteers of Temple Baptist Church to administer first aid or to seek medical care for my child during my child's participation in the program, including transportation of my child to a medical facility for additional treatment that appears necessary.

ART-is-IN CAMP

Participant Registration