Fun and Fitness Week 2016


Rain or Shine
KID’s Fun & FITNESS Summer Camp
July 25th – 29th
9am to 12pm each day
Crocker Field – 356 Broad Street, Fitchburg
In case of rain, we will meet in the church building across the street.

Child's Full Name*

Child's Age*

Allergies

Date of Birth

yyyy-mm-dd

Parent/Guardian*

Home Phone*

Cell Phone

Address*

Email*

Emergency Contact*

Emergency Contact Phone*

Has your child attended fun and fitness in the past?
YesNo

At times we take photos for public view. May we use your child's photo?
YesNo

Anything else we should know?

Agree?*
I/We, the Parent/Guardian listed above of the minor child listed above, do hereby consent to his/her participation in Horizon Christian Fellowship's IMPACT Summer Camp. I/We release Horizon Christian Fellowship, its volunteers, and employees from any and all claims, damages, losses or expenses of whatever kind or nature which said minor may have/acquire resulting from participation in the IMPACT Summer Camp. I/We hereby authorize Horizon Christian Fellowship and its employees and volunteers who are supervising said minor to act on our behalf in authorizing and consenting to emergency medical care for said minor if he/she becomes ill or is injured while participating in this activity. I/We hereby RELEASE AND DISCHARGE Horizon Christian Fellowship from any and all claims of any nature whatsoever, which may arise out of a decision to provide emergency medical care.

Yes

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