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Registration Form - South Hope Day Camp - Summer 2013

Name__________________________________ Address________________________________ City___________________________________ State________ Zip____________ Phone___________________ Age____ Birth date_______ Entering grade____ Church_________________________________ Parent or Guardian________________________ Phone________________ Please provide an emergency contact in case you cannot be reached. Emergency Contact_______________________ Phone_______________ SHCC reserves the right to use your childs picture taken at Day Camp for advertising purposes. Please check this box if you do not want your childs photo used. Please fill out the the other side of this form. Please return completed form to: South Hope Community Church 142 Main Street Hope, Maine 04847

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22-26, 2013

Ages 6-12

Bible Lessons, Captivating Stories, Songs, and Games

Childs Name______________________

Trust in the LORD

and lean not unto thine own understanding. In all thy ways acknowledge him, and He shall direct thy paths.
Daily registration 9:00-9:15 AM Day camp ends at 2:30 PM Donations accepted

with all thine heart;

In the event I cannot be reached in an EMERGENCY, I hereby give permission to the physician or hospital selected by the Camp Director to hospitalize, secure proper treatment for, and to order injection, anesthesia, or surgery for my child as named above.

PARENT'S SIGNATURE* _____________________________________ Printed Name__________________________

Proverbs 3:5-6

Notes to Parents:
Our Purpose South Hope Community Churchs Day Camp is dedicated to providing a well-rounded program to meet the spiritual, mental, and physical needs of boys and girls. We center everything we do on the Gospel of the Lord Jesus Christ. Our Staff Adults and competent young adults, who have been carefully screened by Child Evangelism Fellowship (CEF), will provide constant care of your children. Health and Safety A trained nurse will be present at all times. Children should bring A bag lunch, a Bible if they have one, sneakers or shoes, and a sweater on cool days marked with their name.

Contact: Day Camp Director Ethan Troester 691-0354 Or Pastor Jamie Bickel 790-0161

*Required for those under 18; to be signed by parent or guardian in ink. HEALTH HISTORY (giving approximate dates) 1. Please list all allergies and health concerns.

2. Is Your Child taking any medications? Yes No *If yes, please list.

3. Is your child current on all immunizations? Yes No

4. Has your child been under a physicians care in the last 6 months? Yes No * If yes please explain