Northeast United Methodist Church is an environmentally sustainable, spiritually fulfulling, socially just community of faith in the United Methodist tradition in Northeast Minneapolis.
Northeast United Methodist Church
Wednesday, August 16, 2017
Open Hearts, Open Minds, Open Doors

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: ______________________________

                                                         Parent/Guardian signature

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).

_______________________________________________________   Date: ______________________________

                                                         Parent/Guardian signature