INFO for 2013-- Registration for campers

Hopefully, you can print either this entire blog post, or just the photo, and fill out for registration!  

Camper Registration Form

                   

Child’s Name:___________________ Birth date:________ Age:_______

T-shirt Size: Youth S    M    L  XL  or Adult  S   M      L    XL

Guardian/ Parent Name:_____________________________________

Home phone number:__________ Cell phone number:________________

Address:_________________________

City:______ State:_____ Zip Code:______ email:________________

So we can make sure we best fill the needs of your child, please describe any special accommodations your child will need: _________________________________________________________

_________________________________________________________

We are interested in a scholarship: Yes___ No ____(limited available)

__Yes ___No    I give permission for my child to have his/ her picture in any camp related article, Internet, video, television program to promote this program.

***We have tried hard to keep this camp affordable so all those who want  to come  have the opportunity. However, any extra monetary donation anyone would like to give would be greatly appreciated.****

Please make checks out to Seton, in memo writing SPICE

Please mail registration, emergency contact form, and payment no later than June 9th to:                         

All Abilities Drama Camp

                        St. Elizabeth Ann Seton Church,

                               1730 Summerhill Drive,

                                Lexington, KY 40515

       aadramacamp@gmail.com  www.allabilitiescamp.blogspot.com

                                   859-273-1318 extension 278 

                      Check out our facebook page too!!

*Registration will be considered complete once registration form, emergency contact form, and payment are received. A letter of confirmation of enrollment will be sent after all paperwork is received.

Camper Emergency Card

All Abilities Drama Camp  2013

Camper’s Name:____________________________

Birth date:_____________   Age:_______

Address of Camper:_____________________________________________________

Name of Guardians:____________________________________________________

Home phone:____________________ Cell phone 1:___________________________

Cell phone 2 (if applicable):_________________________ email:_________________

Doctor to call:_____________________  Phone:____________

Other Emergency Contacts:

Name:___________________   Phone number:___________________

Name:___________________  Phone number:____________________

List any serious illness/ condition that might require emergency care: (example: diabetes, epilepsy, heart disease, bee stings, etc.):________________________________________

_______________________________________________________________________

List any allergy to drugs or Anesthetics:_______________________________________

Realizing that sudden illness or an accident may happen to a camper, I hereby ask the authorities to use their best judgment in such cases in caring for my child.

It is understood that an earnest effort will be made to contact parents. If unable to notify me and the situation needs immediate attention, the authorities have my permission to take my child to a physician’s office or to a hospital. Ambulance services may also be provided.

I further understand that the camp is not responsible for any expense incurred.

The hospital and physician have permission to give my child whatever emergency treatment is required until able to contact me.

My signature also authorizes the following people to pick my child up from camp if I am not able to:  

            Name:_______________________________   Name:_____________________

            Name:_______________________________   Name:_____________________

Guardian Signature:_________________________________________Date:__________