Summer Music Camp 2017

FBCW Summer Music Camp Registration Form - $75

July 10-14, 2017 9am-12pm
Parent Name*

First NameLast Name
Mobile Number*

Area CodePhone Number
Work Number

Area CodePhone Number
Parent E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Emergency Contact #1*

First NameLast Name
Emergency Contact #1 Phone Number*

Area CodePhone Number
Emergency Contact #2

First NameLast Name
Emergency Contact #2 Phone Number

Area CodePhone Number
Who else may pick up your child from Music Camp?
May we photograph your child and use their picture for the purpose of promotion?*

Child #1*

First NameMiddle NameLast Name
Grade Entering*
Child #1 Birth Date*

MonthDayYear
Child #1 Allergies
Child #2

First NameMiddle NameLast Name
Grade Entering
Child #2 Birth Date

MonthDayYear
Child #2 Allergies
Child #3

First NameMiddle NameLast Name
Grade Entering
Child #3 Birth Date

MonthDayYear
Child #3 Allergies
Child #4

First NameMiddle NameLast Name
Grade Entering
Child #4 Birth Date

MonthDayYear
Child #4 Allergies
Additional Comments
I am over 18 years old and am the legal guardian of the children registered above. I agree to hold First Baptist Church Weslaco free from all liability relating to injuries that may occur before, during or after Summer Music Camp. By signing this agreement, I agree to hold First Baptist Church entirely free from any liability, including financial responsibility for injuries incurred, regardless of whether injuries are caused by negligence.*

Agree
Student's spot is NOT secure until $25 non-refundable deposit per student is paid. You may pay deposit or full amount at the church office (600 S. Kansas, Weslaco, TX), or via this link (copy and paste in browser): https://onrealm.org/firstbaptistweslaco/Give/KQXBYXJMRL*

I understand
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FBCW Summer Music Camp Registration Form - $75