VBS Registration

An American Baptist Church

Adult Ministries

Teens & Tweens

Children's Ministries

Wednesday Programs

Summer Camp

Imagination to
Creation Camp
2010

July 19 - July 23
9:00 AM - Noon

VBS Registration

Imagination to Creation Arts Camp 2010
Registration Form

Camper's Name:

Mailing Address:
Number/P.O. Box/Route Street/Avenue/Road City, State, Zip

Home Phone:

Date of Birth:

(on July 1st)

Creative Station Rank:
Using the menu items below, rank your top 5 choices:

Praying With Preschoolers (4-5 Year Olds)

Main Contact/Parent/Guardian: Name: Home Phone: Email:	Secondary Contact/Parent/Guardian: Name: Home Phone: Email:
In Case of Emergency, other than above, Contact:
Siblings Attending Camp: First Sibling's Name: Age: Camper or Helper:	Second Sibling's Name: Age: Camper or Helper:

Volunteer Name: I want to help with: Child Care Needed: First Names/Ages I can help Monday Tuesday Wednesday Thursday Friday
Medical Release Information: My child has the following medical allergies, current medications, medical problems or pertinent information that should be known: Physician: Phone: Insurance Carrier: Policy #: I understand that in the event medical treatment is required, every effort will be made to contact me or my emergency contact. However, if I cannot be reached, I give my permission for the First Baptist Church of Rochester or an adult representative of the church or camp to secure the service of a licensed physician to provide necessary care, including anesthesia for my child's well being. Several medically trained and defibrillator and CPR trained representatives are on premises during the camp. Waiver of Liability: I, the parent or legal guardian of the child listed above, release the First Baptist Church of Rochester, together with the adult and teen volunteers of the camp, from any and all claims resulting from injury or damage that may be sustained while my child is participating in the 2010 Imagination to Creation, Creative Arts Camp help between July 19 through July 23. I agree I do not agree Photograph Waiver I/we (above indicated) hereby acknowledge that I/we have reviewed this form and caused it to be electronically executed with the intent to be bound to the terms/pricing, including Medical Release Information and Waivers contained herein. I/we will mail or bring a $25 per camper registration fee to First Baptist Church, 175 Allens Creek Road, Rochester, NY 14618 to complete the registration. I agree I do not agree I/we (above indicated) hereby acknowledge that I/we have reviewed this form and caused it to be electronically executed with the intent to be bound to the terms/pricing, including Medical Release Information and Waivers contained herein.

For more information on the Imagination to Creation Camp,
please contact the church office at 244-2468 or
email imaginationtocreation@gmail.com.

Imagination to Creation Arts Camp 2010Registration Form

Imagination to Creation Arts Camp 2010
Registration Form