All areas are required fields.

Childs Name

Parent/Guardian Name

Address

Your Email

Phone

Childs Birthday

Shirt Size

Grade of Child in Fall 2010

Allergies/Medical Conditions

Emergency Contact Information:

#1 Name:

#1 Relationship:

#1 Phone:

#2 Name:

#2 Relationship:

#2 Phone:

Dismissal Information: Who may pick up your child at the end of they day?

Do you have a home church? If so, where?

May we photograph your child?
yes no 

May we use your child's photograph in church publication?
yes no 

By Submitting this form you agree to the following:
I/We the undersigned, do hereby consent to allow my/our child to participate in the activities during the free sports camp sponsored by Integrity Church of Greenville, NC. I/We understand that the activities will involve a risk factor. Examples included but are not limited to: sports drills, games and other physical activities. I/We give permission for our child to be given medical emergency attention if deemed necessary while under the care of Integrity Church of Greenville, NC.