Saint Michael and All Angels Episcopal Church

Arts Camp Session

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June 13-17, 2022 4 and 5 year olds (going into Kindergarten 2022 and 2023)
July 11-15, 2022 Grade 1-6

Campers' Name(s) and Date(s) of Birth

School Attending

Home Address

Parent/Guardian's Name

Parent/Guardian's Relation to Camper

Parent/Guardian's Preferred Phone #

Parent/Guardian's Alternate Phone #

Additional Parent/Guardian's Email

Additional Parent/Guardian's Name

Additional Parent/Guardian's Phone #

Additional Parent/Guardian's Email

Emergency Contact Name and Phone Number

The above camper(s) has my permission to attend activities with leaders from St. Michael and All Angels Church. I understand activities will be under the supervision of one or more adult leaders approved by the church. I waive any claim against the church and its approved leaders.

Parent/Guardian Consent *

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I agree
I do not agree

In case of medical emergency, I understand that effort will be made to contact me. If I cannot be reached, I hereby give permission to the physician selected by the adult leader to hospitalize, secure proper treatment for and to order injection, anesthesia or surgery for my child named above.

Parent/Guardian Medical Authorization *

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I agree
I do not agree

Medical Insurance (if applicable): Company Name, Policy Number, Member ID #

Family Doctor/Clinic and Phone #

Food or Drug Allergies

Does your child have any needs we should be aware of, so that we may provide him/her with the best possible camp experience? Please explain.

I have read and understand that my child will be expected to follow the ARTS camp rules and behavior guidelines. Violators will be warned: further problems will result in dismissal from camp without reimbursement.

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I agree

I grant permission to St. Michael’s to share photographs and video taken of my child while at Arts Camp for any lawful purpose including publication, promotion, illustration, advertising, trade, or historical archive in any manner.

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I agree
I do not agree

Financial assistance requested

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Please contact me about financial assistance

Saint Michael and All Angels Episcopal Church

Arts Camp Registration Form