Murdale Baptist - MBC Summer Camp Registration

2024 MBC Summer Camp Registration:

Wild Live!

Dates: June 5 - Aug 21
When: Wednesday evenings 6:30 - 7:30 pm
Where: Murdale Baptist Church
For: Children ages 4 yrs old - 5th grade

MBC Summer Camp Registration

WILDLive: June 5 - August 21

Parent/Household Information:

Mother's First Name

Mother's Last Name

Father's First Name

Father's Last Name

Phone Number

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Emergency Contact:

First Name

Last Name

Relationship to Child(ren):

Phone Number

Summer Camp Registration:

(Children Ages 4 - 5th Grade are eligible to participate in MBC Summer Camp.)

Child's First Name

Child's Last Name

Birthdate

Gender

School Grade (Indicate the grade the child just finished.)

Special Needs/Allergies:

Please indicate any Special Needs or Dietary Restrictions the child(ren) may have that we need to be aware of:

Release of Liability/ Consent to Medical Treatment / Photo Release:

**I consent to and approve my child/children's taking part in all activities conducted by MBC Summer Camp. I understand as with any activities, there is a risk of injury. I fully accept this risk and consent to the treatment of any minor injuries of my child, and release, hold harmless, and indemnify MBC and their volunteers and agents from all liability, claims and costs arising from any treatment. I understand every effort will be made to contact me or my emergency contact. However, if I/we cannot be reached, I give my permission to the Summer Camp volunteers to secure services of a licensed medical professional to provide care necessary for my child's well-being. I assume responsibility of all costs connected to any accident or treatment of my child.

**I give permission for my child's photo which may be taken during MBC Summer Camp to appear among other general photos in all media published by MBC. Names will be withheld unless consent is requested.

Photo Permission:

Yes

Signature

Today's Date:

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