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UNION BAPTIST CHURCH
SUMMER CAMP REGISTRATION FORM 

Union Baptist Church does not discriminate based on race, color, sex, religion, or national origin. Union Baptist Church and staff reserves the right at its sole discretion to refuse an application or dismiss a child from camp. No refund will be made of fees if the child has attended any portion of the camping period. I understand and accept these guidelines Parent/Guardian's Signature: I give Union Baptist Church permission to photograph and/or videotape my child for public relations and/or marketing purposes during any time of camp activities and field trips. I give permission for Union Baptist Church to transport my child off camp property for the purpose of field trips and/or medical care. I understand that a schedule of events will be available to me and that all events are subject to change due to weather and/or scheduling conflicts without notice. I authorize the camp management to act as the agent of the parents in any emergency or to administer basic first aid for the health and welfare of the camper involved. I am responsible for the expenses involved if the services of a physician or hospital are required. Please request a waiver for persons requesting exemption from medical treatment. Hospital preferred By signing, I agree to adhere to all the Policies and Procedures set for by Union Baptist Church.

PLEASE READ THIS PARENT AUTHORIAZATION FORM FIRST

Child Resides with

By signing this form authorize that you have read and fully understand the the Parent Authorization Form that is on this page and you agree with all aspects of it.

STUDEN'TS MEDICAL INFORMATION FORM

Birthday
Month
Day
Year
Date of last physical
Month
Day
Year
Date of last Tetanus shot
Month
Day
Year
Will your child need to take any prescription medications while at camp? If Yes please request a medical dispensing form. Return the form and medication in a zip lock bag with your Childs name on the first day that they attend camp.
Yes
No
Does your child have allergies?
Yes
No
N/A
Is your child restricted from specific Activities?
Yes
No
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