Peace Camp 2023 registration
For children who are have completed K through 5th grades - all are welcome!

Sunday, June 18 - Thursday, June 22 --- 5-8 p.m. Dinner included!
480 Groffs Mill Rd. Harleysville, PA 19438
(215) 256-0778  peacecamp@salfordmc.org

Please register by Sunday, June 4.

Please also use this registration to register any youth/Jr. Counselors. 
Sign in to Google to save your progress. Learn more
Email *
Parent/Guardian First Name *
Parent/Guardian Last Name *
Parent/Guardian Email *
Parent/Guardian Cell Phone *
Emergency Contact Name (would be contacted after person listed above) *
Emergency Contact Phone Number *
Who is allowed to pick up your child(ren)?
I give permission for Salford Mennonite Church to post pictures of my child on the website, social media, and/or in SMC publications. (names are not attached to pictures) *

LIABILITY RELEASE: In consideration of Salford Mennonite Church allowing the above child(ren) to participate in Peace Camp activities, I, the undersigned, do hereby release, forever discharge, and agree to hold harmless Salford Mennonite, its directors, employees, volunteers, and agents from any and all liability, claims, or demands for accidental personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever that may be incurred by the undersigned and the above child(ren) while involved in Peace Camp. Furthermore, on behalf of my minor child(ren), I hereby assume all risk of accidental personal injury, sickness, death, damage, and expense as a result of participation in activities involved therein. As well as releasing the child(ren), if necessary, for transportation to and from the Peace Camp location, I, the undersigned, do hereby release, forever discharge, and agree to hold harmless Salford Mennonite, its directors, employees, volunteers, and agents from any and all liability, claims, or demands for accidental personal injury in the process of transportation.

MEDICAL TREATMENT PERMISSION: I authorize an adult, in whose care the minor has been entrusted, to consent to any emergency X-ray examination, anesthetic, medical, surgical, or dental diagnosis or treatment and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed on the medical staff of a licensed hospital or emergency care facility. The undersigned shall be liable and agree(s) to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child(ren) pursuant to this authorization.

*
Child 1 First Name *
Child 1 Last Name *
Child 1 Grade (entering in fall 2023) *
Child 1 t-shirt size: *
Allergies, Dietary Restrictions, Medications, and/or Medical Conditions?  *
Other important information to know about your child to help them feel welcome and engaged (triggers, effective calming strategies, challenges)? *
Other children or youth to register? 
Clear selection
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy