Soaring Eagles Summer Camp Registration

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Camper's Last Name: *

Camper's First Name: *

Middle Initial:

Street Address: *

City: *

State: *

Zip code: *

Check one: *

Boy
Girl

Date of Birth: *

The child must be 5 yrs old by 5/31 to attend camp.

Last Grade Completed: *

Mother/Guardian Name: *

Best Phone Number: *

Email *

Father/Guardian Name: *

Best Phone Number: *

Email *

1st Emergency Contact Name: *

Relationship to Child: *

Home Phone Number: *

Cell Phone Number: *

2nd Emergency Contact Name: *

Relationship to Child: *

Home Phone Number *

Cell Phone Number *

T-Shirt Size (Choose one): *

Please Choose The Camp Sessions Your Child Will Attend: *

Full Time / Session #1 (2 weeks) July 5 - July 14 = $470.00
Full Time / Session #2 (2 weeks) July 17 - July 28 = $470.00
Full Time / Session #3 (2 weeks) July 31 - Aug 11 = $470.00
Full Time / Session #4 (2 weeks) Aug 14 - Aug 25 = $470.00
Part Time Tues-Thrs ONLY / Session #1 (2 weeks) July 5 - July 6, July 11 - July 13 = $235
Part Time Tues-Thrs ONLY / Session #2 (2 weeks) July 18 - July 20, July 25 - July 27 = $235
Part Time Tues-Thrs ONLY / Session #3 (2 weeks) Aug 1 - Aug 3, Aug 8 - Aug 10 = $235
Part Time Tues-Thrs ONLY / Session #4 (2 weeks) Aug 15 - Aug 17, Aug 22 - Aug 24 = $235

REGISTRATION DETAILS:

TUITION DETAILS:

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Is your child under any medical/physical restrictions? *

Yes
No

If YES, check all that apply:

Other medical/physical restrictions:

Is your child taking any medication? *

Yes
No

If YES, please list:

Has your child been under a doctor's care or hospitalized within the last three years? *

Yes
No

If YES, please explain:

Is your child allergic to any medications/foods/insect stings? *

Yes
No

If YES, please list:

Family Health Care Provider's Name: *

Provider's Telephone: *

Provider's Address: *

Paragraph Text

Parent/Guardian Signature: *

Your typed name will serve as your signature.

Date: *

AUTHORIZATION:

I hereby give consent for my child to participate in camp-sponsored activities supervised by authorized staff while off campgrounds. I understand that every reasonable precaution will be taken to protect the health and safety of my child and that The Academy of ELCC/Soaring Eagles Summer Camp or its affiliates or any adult sponsor(s) shall not be held liable for any injury my child may sustain while on camp field trips and pool trips. If an emergency illness or injury occurs, I hereby authorize The Academy of ELCC/Soaring Eagles Summer Camp to treat and/or send my child to a physician or hospital and authorize the necessary treatment. I also authorize the physician or hospital to release my child after treatment to a representative of The Academy of ELCC/Soaring Eagles Summer Camp. I give permission for my child to participate in neighborhood walking trips within 2 miles of The Academy of ELCC, including trips to and from Eternal Life Christian Center Church located at 322 Franklin Blvd., Somerset, NJ 00873. Also, I give my child permission to be photographed or videotaped for The Academy of ELCC/Soaring Eagles Summer Camp. All information on this form is complete, true and accurate to the best of my knowledge.

AGREEMENT:

Parent/Guardian Signature: *

Your typed name will serve as your signature.

Date: *

In order to attend camp each child must: