Smiley Camp Registration

Welcome to online registration for Smiley Camp! We appreciate you choosing Smiley Camp at 2nd Presbyterian Church for your child this summer. It is our prayer that they may grow mentally, physically and spiritually through this experience.

Cost per Camper:

June 14-18 9:00am-2:00pm – $200
June 21-25 9:00am-2:00pm – $200
Both Weeks – $350

6 years olds are now full.

Family Information

Parent or Guardian #1

Name:

Street Address:

City:

State:

Zipcode:

Phone Number:

Email Address:

Parent or Guardian #2

Name:

Street Address:

City:

State:

Zipcode:

Phone Number:

Email Address:

Emergency Contact (other than parent)

Name:

Phone Number:

Relationship to Child:

Person(s) to whom your child may be released other than Parent/Guardian:

Camper Information

Camper #1

Name:

Gender:

Birthdate:

Age by August 2021

Returning Camper?

Weeks Attending June 14-18 June 21-25

Church Presently Attending:

School Presently Attending:

Potty Trained?

Class in Fall:

T-Shirt Size:

Allergies:

Insurance Information

Insurance Company:

Policy Holder:

Policy Number:

Family Physician:

Physician's Phone Number:

Permission to Administer Medication

I (We), the parent(s) or legal guardian(s) of the camper named below, give permission for personnel of Smiley Camp to dispense prescription or over the counter medicines to my child provided by me. All medicines must be turned into the child's teacher or camp director. Medicines must be in the original containers and clearly labeled.

Name of Child: Name of Medication(s): Reason for Medication(s): Dosage/Time/Dates to be given:

NOTE: Emergency medicine such as Epi-pens or inhalers MUST be placed in a zip-lock bag labeled with the child's name and a picture of the child enclosed.

Comments: Parent/Guardian Signature:

Date:

Statement of Release

My child has permission to participate in all camp activities and to use play equipment under supervision except for limitations noted. I agree that Smiley Camp, Second Presbyterian Church, and staff will not be held responsible for accidents or injuries arising from participants in the program. I grant permission for the camp personnel to provide routine health care and to seek emergency medical care if warranted. I grant permission for my child to be included in documentation of activities or programs through the use of videos, photos, or printed materials, which may include class photos, area newspaper articles, Second Presbyterian Church and Week Day School Websites or filmed segments to be aired on local TV stations. In consideration of my child's opportunity to participate in the camp program, I agree to release and hold harmless, Second Presbyterian Church, its agents, representatives, and employees from all claims, damages, or liabilities concerning my child which are not the result of gross or intentional negligence or willful or wanton conduct by the camp, it's agents, representatives or employees.

Coronavirus, COVID-19 is an extremely contagious virus that spreads easily through person-to-person contact. Federal and state authorities recommend social distancing as a means to prevent the spread of the virus. COVID-19 can lead to severe illness, personal injury, permanent disability, and death. Participating in the Event could increase the risk of contracting COVID-19. Second Presbyterian Church in no way warrants that COVID-19 infection will not occur through participation in the Event.

Parent/Guardian Signature:

Date: