In the event of an emergency or if medical attention is needed we will contact the listed parents/guardians. However, if we can not get a hold of parent/guardian, I/we, the Parents or guardians named below, authorize Plattsville Church Personnel to sign a consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant named above. I/We will inform the church staff if my child has had a communicable disease within the three weeks prior to his/her attendance at day camp. The church has my permission to contact my family doctor.

Plattsville Church�reserves the right to dismiss a participant who, in their�opinion, is a hazard to the safety and right of others, or who appears to have rejected the reasonable controls of the Kidz Time. The parents or guardians submitting this application are those having legal custody over the child. Conditions of custody, if applicable will be fully communicated in writing to the Church, including a photocopy of the section of any court order referring to visitation rights. While every precaution shall be taken to ensure the good welfare and protection of the camper, Plattsville Church, its staff members, volunteers, or facilities, are hereby released from any and all liability in the event of any accident or misfortune that may occur to the applicant camper. I give permission for Plattsville Church to use any photograph or video footage my child is in for promotional materials. The parents/guardians hereby agree to reimburse the Church for any damage caused by the applicant. Any medical, behavior or one on one conditions have be mentioned on this application. I have read all sides of this application form, understood the above information, and I hereby accept the conditions of enrollment.