Sports & Art Camp Registration

2018 BE Free Sports & Art Camp

Camper Registration

Camper's Full Name:*
First Last
Gender:*
- Male
- Female
Birth Date:*
MM
DD
YYYY
Grade Camper Completed in June 2018:*
Camper T-Shirt Size:*
Kids will receive their shirts on the first day of camp to wear for the duration of the week.
Name of Parent or Legal Guardian:*
First Last
Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone:*
Cell Phone:*
Email address where you'd like to receive confirmation and information:*
Enter Email Confirm Email
How did you hear about Sports & Art Camp?
Medical Information
1st Emergency Contact Name:*
First Last
1st Emergency Contact Relationship to Camper:*
1st Emergency Contact Daytime Phone:*
2nd Emergency Contact Name:*
First Last
2nd Emergency Contact Relationship to Camper:*
2nd Emergency Contact Daytime Phone:*
List any allergies:*
If none, enter "none."
Please list any special needs or physical limitations that the camp staff should know about.*
If none, enter "none."
Liability/Photo/Video Release
I, as a parent or legal guardian of the registered child, grant permission for the registered camper to attend BE Free Sports and Art Camp. I do hereby release Branford Evangelical Free Church (BE Free) from any and all liability or responsibility due to any injury that he/she/I may incur as the result of, or arising in any way from participation in activities at or under the direction of BE Free Sports and Art Camp. I am fully aware and consent to accept these risks and voluntarily agree to allow his/her participation in activities. If I cannot be consulted in an emergency, I hereby give permission to the physician selected by a representative of BE Free Sports and Art Camp to hospitalize, secure treatment for, and to order injections, anesthesia, and/or surgery for the person named above. I understand that BE Free Sports and Art Camp only carries secondary insurance and that I will take primary responsibility for any fees or charges at any clinic, facility, or hospital arising from treatment of injury or illness. I furthermore understand BE Free Sports and Art Camp often takes photographs or videos of participants during its activities or events. I grant permission without compensation that these photographs or videos may be used in publications, presentations, websites or promotion of BE Free Sports and Art Camp or Branford Evangelical Free Church. BE Free Sports and Art Camp will not identify me or my child by name or release any other personal information without additional written consent from me.
Electronic Signature*
Select One:*
- Team 45: $55, ages 4 & 5 (must be 4 by July 23, 2018).
- Basketball: $55, ages 8-12 (must turn 8 by July 23, 2018), ball needed.
- Cheerleading: $55, ages 6-12 (must turn 6 by July 23, 2018).
- Soccer: $55, ages 6-12 (must turn 6 by July 23, 2018), ball and shin guards needed.
- Flag Football: $55, ages 6-12 (must turn 6 by July 23, 2018).
- Arts & Crafts: $75, ages 6-12 (must turn 6 by July 23, 2018), includes additional materials fee of $20.

*Please Note: If you have a Paypal account affiliated with your debit/credit card, please click “Pay with my PayPal account” to sign into the account for payment or PayPal may reject your card. If you do not have a PayPal account, simply click, “Pay with a debit or credit card, or PayPal Credit.”

Medical Information

Liability/Photo/Video Release