Camper's Name *

First Name

Last Name

Phone # *

(###)

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Emergency Contact # *

(###)

###

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May we photograph your child for promotional purposes? *

Yes

No

Liability Release: As the parent or legal guardian of the child I am registering, I authorize the leadership of Faith Lutheran Church of Quincy, MA to care for the administration of the first aid treatment for any minor injuries my child receives during the event. If the injury sustained is life threatening, or needs emergency treatment, I authorize said leadership to summon any emergency personnel to attend, transport, and treat my child. I agree to hold any staff, assistants, and volunteer workers harmless from all claims, suits, costs, and actions of any kind whatsoever, arising from their exercise of power granted by this authorization. *

First Name

Last Name