2019 Children’s Free Day Camp
Online Registration Form
(hard copies available, call 865-453-0124)

June 17 - 20, 2019; For Children having currently finished Grades 1 - 6. This Day Camp is Free. Please fill out ALL fields requesting information. By digitally signing and submitting this online registration form for your child, you commit to have your child attend if at all possible. We will have prepared a lot for your child to be here. Please inform us asap as to if your child isn’t able to come. Please fill out one form for each child. 

I understand that it is ok for my child to attend only one day or may attend all four days. My child is to be dropped off at 9:50 am and may be picked up at 3:00 pm. Lunch is provided for my child along with snacks/refreshments. My child will be Attending One or More of the following Days. (Please check the appropriate boxes):

Have all meds clearly labeled with child’s name, med name, instructions and bagged in a clear ziplock bag. Meds to be turned in during registration.

A certified CPR/Nurse will be on campus.

The person described on this registration form has my permission to be in all activities at the designated places during the dates associated with this camp, except as noted by me and listed on the bottom of this sheet. If a medical emergency should arise for my child at this camp and I cannot be reached, I consent and give permission to the Camp Director, Camp CareTaker or Day Camp Director to select a physician and/or hospital for care. LeConte Hospital, Sevierville, will be selected if no other preference is given. I also give the physician and/or hospital, as selected by the Camp Director, Camp CareTaker or Day Camp Director, my permission to hospitalize, treat, give x-rays, test, order injections, anesthesia, or provide surgery for my child who is named herein. I do release, acquit, discharge, and covenant to hold harmless Sevier County Association of Baptists, Camp Smoky Christian Retreat, First Baptist Church, Jefferson, Ga., the Camp Director, Camp CareTaker or Day Camp Director of any and all actions, damages, or liabilities arising out of the treatment of any sickness, or accident incurred by my said child. Parental/Guardian acknowledgement and consent:

Parent/Guardian: If you have a special needs child, you must be willing to be present with your child throughout the entire Day Camp. Handicap facilities are available at each end of campus. But our overall facilities and staff are not trained or prepared to host a special needs child without parental guardianship being present. You are welcome to take advantage of our facilities as to the accessibility allows, for everyone’s well being and comfort.

Any questions or concerns, please call Robert Nichols at (865) 603-0701.

Notary Public 
All information: personal, medication and emergency information is correct.
Parent's Signature_________________________ Date _____________ 
Notary Sign and Seal _________________________ *can be notarized at camp registration table for free!

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