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REGISTRATION FORM

(please print)

July 27 - 31, 2009 | 9 – noon | at First Federated Church

Child’s Name: Child’s Age:Address: Apt. No.:City/State: Zip:Home Phone: Work Phone:Cell Phone: Child’s Date of Birth:E-Mail: School Grade Completed:Mother’s Name: Father’s Name:Emergency Contact Name: Emergency Contact Phone:+Allergies or Other Medical Conditions We Need to Know of:

+Note: We are a peanut-free zone.

Others Persons You Give Permission to Release Your Child to:Relationship(s):

Children will not be released to others unless listed by parent.

Circle Shirt Size: YS YM YL AS AM AL AXL

(6-8) (10-12) (14-16)

Please complete Medical and Liability Release on the back of this form.

Workshop Choice No. (1, 2, 3)

Drama __________ Media

(limited #)

__________ Set Design __________ Vocals __________ Dance __________

CAMP REGISTRATION FEE IS $25. AFTER JUNE 15

rd

: $35.

Please make checks payable to First Federated Church.Each child attends only one workshop for the week.Please see detailed descriptions of workshops tohelp you and your child determine appropriateselections (some age and ability restrictions apply).Please indicate your first, second, and third choicesfor camp workshops. All effort will be made to placeyour child in the first choice if possible.