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1. Online Registration for June 17-19, 2014
for Creative Science Investigators (CSI)
at Westend Christian Reformed Church
Thank you for signing up!
Each day will have a new theme:Electrifying Electricity, Amazing Plants , and Birds of Prey!!
Please complete the form below to register your children to participate.Children entering Kindergarten through 5th grade this Fall 2014 may attend.
Click "Submit" at the bottom of the form to send in this online science camp registration to Westend Church. |
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2. Please enter your contact information below.
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| 3. Emergency contact name and phone number | | |
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| 4. Church Affiliation (not required) | | |
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5. Enter each child's name, birthdate, and the grade the child is entering this Fall 2014. Please enroll only kids entering Kindergarten through 5th grade in Fall 2014.
Click on each cell to enter the information or use the Tab key to tab over from one cell to the next.
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| 6. Please list any special medical concerns (including allergies): | | |
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| 7. If someone other than the parent is picking up the child(ren), please list their name, phone number, and relationship below: | | |
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| 8. There may be transportation available. If you need that option, please describe when below: | | |
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| 9. If your child is not able to physically participate in certain activities, please indicate that below. | | |
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| 10. If your child would like to be with a friend, please list both names below. | | |
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| 11. Do you have other comments or questions? | | |
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* 12. General Release of Liability and Authorizationfor Medical Treatment
The child(ren) listed above have permission to engage in all science camp activities, except as may be noted directly above. In consideration for my child(ren) being allowed to participate in Westend Christian Reformed Church's Creative Science Investigators Science Camp, I agree to assume the risk of such activities and programs and further agree to hold harmless Westend Christian Reformed Church and its staff members or volunteers conducting the activities from any and all claims, suits, losses, or related causes of action for damages including, but not limited to, such claims that may result from injury or death, accident, or otherwise, during or arising in any way from the activities. Westend Christian Reformed Church is not responsible for lost, stolen, or damaged personal articles. I also authorize Westend Christian Reformed Church and its assignees to use any photograph, picture, or likeness of me or my child for promotional purposes. In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by Westend Christian Reformed Church to secure and administer treatment, including hospitalization, for my child(ren) as named above. I acknowledge that this General Release of Liability and Authorization for Medical Treatment of Westend Christian Reformed Church is legally binding on me personally and on my heirs, personal representatives, successors, and assignees. |
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| * 13. Please enter today's date: |
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| 14. How did you find out about Creative Science Investigators (science camp)? Please check one or more that apply. |
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