Made to Move Faith-Based Dance Camp

Child's Information

Photo

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First and Last Name

Gender

Date of Birth

Grade for the 25-26 school year?

Does your child have any medical conditions we should be aware of?

Does your child have food allergies or dietary restrictions?

Parent's Information

First and Last Name

This address will receive a confirmation email

Phone

Address

Emergency Contact Information

First and Last Name

Relationship to child

Contact Phone Number

Medical Release

In case emergency medical treatment is needed, I give permission to the staff of the First United Methodist Church of Round Rock, or anyone acting on its behalf, to obtain necessary emergency medical treatment, by a licensed physician, hospital or clinic for my child. In providing consent, I understand that FUMC-RR does not have a medical staff on campus and that all decisions regarding the need for emergency treatment will be based upon reasonable judgment of the FUMC-RR, or its designee. I release FUMC-RR, and its staff, from any and all liability, claims, demands or causes of action related to any loss, damage or injury which may occur while my child is attending the camp.

Media Release

I hereby grant permission for First United Methodist Church of Round Rock to use photographs, voice recordings and video recordings (collective, the Images) of my child on the church-wide website, social media, electronic communique, displays and/or other official printed publications.

Payment

Camp Cost $40.00

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Made to Move Faith-Based Dance Camp

Description

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