Northeast United Methodist Church
Sunday, April 23, 2017
Open Hearts, Open Minds, Open Doors
Northeast United Methodist Church is an environmentally sustainable, spiritually fulfulling, socially just community of faith in the United Methodist tradition in Northeast Minneapolis.
2017 Day Camp Registration
Eco-Kids Day Camp Registration: August 7-11, 2017
Child’s name: ______________________________________________________ Date of Birth: ____/____/____
Grade entering in Fall 2017: _____ Name of parent or guardian: ________________________________________
Street Address: _______________________________________________________________________________
City: ___________________________________________________ Zip Code: ___________________________
Home Phone: ( ) ____________________________ Cell Phone: ( ) ______________________________
Email Address: _______________________________________________________________________________
NEW: Our camp fee this year is $75 per child. Please check one of the options, below:
I can pay the full amount, $75
I cannot pay the full amount, but I can pay $40
My child can only attend camp with a full scholarship.
Allergies / Special health concerns / dietary needs:
Insurance Company: ____________________________________ Insured’s Name: ________________________
Policy Number: ___________________________________ Group/ID Number: ____________________________
PARENTS: My child may participate in Eco-Kids Day Camp. I give permission for my child to receive emergency medical care if necessary. I give the adult volunteers, clergy or church staff the authority to act on my behalf with respect to my child’s health and safety while in Eco-Kids Day Camp, with the understanding that I will be contacted as soon as possible should the need arise. I accept full responsibility for any expenses for medical treatment for my child. I release Northeast United Methodist Church, Community United Methodist Church, Faith United Methodist Church and their representatives from liability in the event of accidental injury or illness. Furthermore, my child has permission to participate fully in Eco-Kids Day Camp activities, including field trips.
_______________________________________________________ Date: ______________________________
I give permission to have images of my child placed in brochures or posted on the website or Facebook page of Northeast United Methodist Church, Community United Methodist Church, or Faith United Methodist Church. (Names of children will not be used).