Confident 2022 Sports Camp Registration

Participant Information

Please indicate the grade that your child will be entering in the fall.

Choose one sport - your child will participate in the same sport all week.

Let us know if your child has any food allergies, so that we can plan snacks accordingly.

Name

Birthdate

Grade

Gender

Sport

Shirt Size

Allergies

Does your child have any special or unique needs that may affect his/her participation in Sports Camp? What supports or accommodations would help your child enjoy Sports Camp to the fullest?

Emergency Information and Release

Please give the name and contact information for your child's primary physician and dentist, in case of an emergency.

Please give the name and contact information of an emergency contact that we may call in case we are unable to reach you.

Please check the box to indicate that you have read and agree to the permission and medical release.

Physician Name and Phone Number

Dentist Name and Phone Number

Emergency Contact (if parent cannot be reached)

I give permission for my child to participate in on- and off-site activities and events. This release is completed by my own free will and with the purpose of authorizing medical treatment under emergency circumstances by Grace Church Salida and its staff, agents, supervisors, and representatives. I understand and acknowledge that it is my responsibility to update and resubmit this form to Grace Church Salida staff in the event of any changes or modifications. As the parent/guardian, I understand and acknowledge that accidents or an acute illness may occur while my child attends Grace Church Salida. In such situations, I understand and acknowledge that immediate steps must be taken to secure my child’s health. Accordingly, I hereby authorize the staff of Grace Church Salida to seek immediate medical attention for my child. It is understood that every effort will be made to notify me or the physician listed before medical services are provided. However, the failure to reach me or the designated physician shall not prevent the application of immediate, necessary emergency medical and surgical care to my child including, but not limited to, arranging for ambulatory care and transportation, injection, anesthesia, or surgery. I further agree that Grace Church Salida, its staff, agents, supervisors, and representatives are hereby released and shall be held harmless in the even of accident, injury, or acute illness to my child. I understand and agree that Grace Church Salida disclaims any and all liability in the unlikely event of injuries or illnesses sustained in connection with my child’s participation in Grace Church Sports Camp. I agree to accept personal responsibility for payment of any and all medical services provided.

I have read and agree to this permission and medical release

Parent/Guardian Information

Parent/Guardian Name

Phone

Address

This address will receive a confirmation email

Payment

If you are registering multiple children from the same family, the first child's registration fee is $30.00. Additional children are discounted to $20.00 each. There are several scholarships available if finances are a concern. Please contact Jessica Weeks at kids@gracechurchsalida.com for scholarship approval.

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Confident 2022 Sports Camp Registration

Description

Please Fix the Following