St. James’ Outreach Camp Registration Form

For Rising 6^th, 7^th and 8^th Graders

August 27^th – 30th

Registration Date:__________

Camper’s Name:

Address:

City/State/Zip:

Email:

Home Phone: Grade:

Date of Birth:

Gender: T-Shirt Size: Sm__ Med__ Lg __

Any special physical or dietary needs:_______________________________________

________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

The cost for the week is $25 and includes drinks, snacks, and transportation. Please make checks payable to “St. James’ Episcopal Church.”

Parent/s’ Medical Release Form

Please be sure to sign

I hereby give my permission for my child/children ________________, ______________

To attend St. James’ Outreach Camp 2007. In the event of accident or illness, I give my permission for him/her/them to receive emergency medical treatment as deemed necessary by a licensed physician.

Signature____________________________________

Printed Name_________________________________

Home Phone_________________________ Cell Phone____________________

Work Phone_________________________

Insurance Co_____________________Policy #___________________________

Emergency Contact: Name________________________________________________

Home Phone_______________________Cell Phone________________________

Work Phone_____________________