Please complete the form below to register for Go Off-Roading, the Community Chapel summer camp week.  July 10-14, 2017.If you have any questions please contact the Community Chapel office. We will still need your actual signature when you arrive to drop off and sign out at the end of the night.

Child #1 Name
Child #1 Name
Child #2 Name
Child #2 Name
Child #3 Name
Child #3 Name
Address
Address
Parent/Guardian Name
Parent/Guardian Name
Best Phone #1
Best Phone #1
Best Phone #2
Best Phone #2
Emergency Contact
Emergency Contact
in the event of emergency and parent/guardian cannot be reached
Emergency Phone
Emergency Phone
A snack will be provided. Please send along a snack if your child(ren) has food allergies or restrictions. We will have a gluten-free, dairy free item.
Medical Release *
It is understood that every precaution will be taken for the safety and well being of my child(ren). In the event of an accident or sickness, however The Community Chapel, its staff and volunteers are hereby released from any and all liability associated with the above activity by The Community Chapel, its staff, volunteers or agents. In the case of medical emergency, I understand that hospital policy requires parent/guardian permission before treatment. I hereby give permission to a representative of The Community Chapel to secure proper medical treatment if a parent or guardian cannot be reached.
Photo/Video Image *
I agree to and realize that my child(ren) may be in photographs take during the program. I waive the right to inspect or approve the photo if used for publications or publicity in social media or print.