SUMMER DAY CAMP at ST PHILIP’S, 2015

Registration Form


Child's Name:  -------------------------------------------- Child's Gender:  -----------------------------------


Child's Age:  --------  Date of Birth:  ----------------  Grade:---------


Name of Parent(s)/Guardian(s):------------------------------------------------------------------------


Street Address:  -------------------------------------------------------------------------------------------


Town:  ------------------ Prov:  ---------- Post.Code:--------------------


Home Tel:  (------) --------------------  Work Tel:  (-------) --------------------


Cell:  (------) ----------------------- Home Email:  ------------------------------------------ 


Who will be picking up your child each day?--------------------------------------------------------


Relationship to Child:  ------------------------------

(When you drop off your child, please notify us if this arrangement has changed, even temporarily!  We will not release a child to anyone except those persons who have been authorized as a pick up person by the parent or guardian.)


Medical Information:  Please make sure to complete this section in detail.


Allergies or other medical conditions:  


--------------------------------------------------------------------------------------------------------------------


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Emergency Contact:  ----------------------------------------------------  


Tel: (------) -----------------------  Relationship to Child: --------------------------------------------- 


Home Church: ---------------------------------------------------------------------------------------------


Signature of Parent/Guardian:  --------------------------------------------------------------------------


Signature of Camp Registrar:  ---------------------------------------------------------------------------


Date:  ------------------------------------------------------------- 



This information will be held inthe strictest confidence by St. Philip's Anglican Church.  It will not be used for advertising purposes, or, shared with any outside person, group, or, organization.