Summer Day Camp Registration Grades K-5
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Mother's First and Last Name *
Father's First and Last Name
Email Address *
Phone Number *
Home Address *
Emergency Contact (not parent) *
Emergency Contact Phone Number *
Persons approved to pick up my child(ren): *
Child #1 First and Last Name *
Date of Birth *
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DD
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Grade Completed *
Medicare Number *
Allergies or Medical Conditions *
Please select which camp(s) your child will be attending: *
Required
I agree on behalf of myself, my child named herein to participate in this ministry of Salisbury Baptist Church, its leaders, volunteers/chaperones, its employees, or representatives associated with the event, from any claim arising from or in connection with my child attending the event or in connection with any illness, injury or medical treatment therewith. And I agree for my child to receive medical attention (if required) while with the church, its leaders, its employees, chaperones, or representatives associated with the event provided by Medicare. And if any costs are not covered by Medicare, I am responsible for the fees and expenses which may incur in any action brought against my child as a result of such injury or damage.
Emergency Medical Treatment: In the event of an emergency, I hereby give permission for Salisbury Baptist Church and its representatives to transport my child to a hospital if emergency medical or surgical treatment is necessary. SBC will notify the parent/guardian/emergency contact if such is the case.
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I give permission for my child's photograph to be taken and used by Salisbury Baptist Church on their website and/or social media platforms. 
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Do you wish to register another child? *
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