Online Form Child`s Name (First, Last)

For TFH Office Use Only: Paid in full: AC Jr. $60_______ AC $75________ Parent volunteer $10 off _______ Other: ________________________________________________________ Paid with: Credit Card ___ Check ___ Cash ___ Child’s Name (First, Last): ___________________________________________________________________________________________ Gender: M___ F___ Age: ______ Date of Birth: _____/_____/________ Tshirt Size (2T, 4T, 6, etc.): _________ Please list one or two friends of your child that are attending Adventure Camp (Optional): _________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ Session Attending: _____ June 16th -­‐18th (3-­‐ 5 y/o) $60 Session 1 (Vacaville) 9 a.m. – 11 a.m. _____ June 23rd-­‐25th (3-­‐5 y/o) $60 Session 1 (Vacaville) 9 am. – 11 a. m. _____ June 16th – 18th (6 – 12 y/o) $75 Session 2 (Vacaville) 5:30 p.m. – 8:30 p.m. _____ June 23rd-­‐25th (6-­‐12 y/o) $75 Session 2 (Vacaville) 5:30p.m. -­‐ 8:30 p.m. **If your child attends Kids Church at our East Bay or Napa campuses, we will be driving kids to and from these locations on a bus provided by TFH for week 1 (June 16th-­‐18th) session 2 (ages 6-­‐12) ONLY. Parent’s Information: Name: _______________________________________________________________________________________________________________ Phone # we can reach you at: ______ -­‐ _______ -­‐ ________ Email: ________________________________________________ Street Address: _____________________________________________________ City/ZIP: ______________________________________ Child’s Medical Information: List allergies, including insects: ____________________________________________________________________________________ ________________________________________________________________________________________________________________________ Last Tetanus Booster: _____/_____/_____ Online Form Daily medication and Dosage: ______________________________________________________________________________________ ________________________________________________________________________________________________________________________ Emergency Contact (Other than parent[s]): Name: _________________________________________________________________ Cell Phone #: ________________________________ In CASE I AM UNABLE TO SIGN OR GIVE VERBAL CONSENT IN AN EMERGENCY I HERBY AUTHORIZE the admission of any medical treatment deemed necessary by The Father’s House registered nurse and/or any physician licensed under the provisions of the Medicine Practice Act on the staff of a licensed hospital during the above dates. I REALIZE THAT INSURANCE PROTECTION IS MY RESPONSIBILITY. Insurance company name:_______________________________________________________________________________________ Policy #:_____________________________________________________________________________________________________________ ____________________________________________ _______________________________ (Parent/guardian Signature) (Date) For Week 1 (June 16-­‐18th) Session 2 (Ages 6-­‐12) ONLY!!! *Will Your Child be using the Shuttle Bus from the Napa / East Bay Campus to the Vacaville Campus and back? Yes __________ No____________ Note: if you use the shuttle bus service your child must ride there and back. Please return this application with your form of payment to the church office (126 Peabody Rd. Vacaville, CA 95687) or to any of our Children’s Ministry Rooms on the weekend. Online Form What you need to know: (Please take this page home) Dates: Coming to Adventure Camp: June 16th-­‐17th (Tues. – Thurs.) Session 1 (3 – 5 y/o) 9 a.m. – 11 a.m. Session 2 (6 – 12 y/o) 5:30 – 8:30 p.m. June 23rd – 25th (Tues. – Thurs.) Session 1 (3 -­‐ 5 y/o) 9 a.m. – 11 a.m. Session 2 (6-­‐12 y/o) 5:30 p.m. – 8:30 p.m. Snacks Your child will need to eat a full meal before coming to Adventure Camp. We will provide a light snack (Pretzels, Goldfish Crackers, or a Popsicle) and water at each session. If your child cannot have one of these snack options, please let us know and we will have an alternative snack available. Online Form Session 1, ages 3-­‐5 (Vacaville): On Tuesday, June 16th/23rd you will need to check your child into camp in the Ministry Center (Kids’ Church Room) at the Vacaville Campus of The Father’s House. Check-­‐in Starts at 8:30 a.m. Camp will start promptly at 9:00 a.m. so getting there early guarantees your child will get the full camp experience. Session 2 ages 6-­‐12 (Vacaville): On Tuesday, June 16th / 23rd you will need to check your child into camp in the Ministry Center (Kids’ Church Room) at the Vacaville Campus of The Father’s House. Check-­‐in Starts at 4:30pm. Camp will start promptly at 5:30pm so getting there early guarantees your child will get to experience the full night. Shuttle Bus (Napa & East Bay): On Tuesday, June 16th, you will need to check your child into camp in the Napa Campus lobby or the East Bay Campus parking lot. Check in at both campuses starts at 4:00pm and will return at 9:15 pm. The Shuttle bus will leave promptly at 4:30pm. Your child will be fed dinner on the bus. Picking my child up: When picking your child up from camp there will be a designated “IN” and “OUT” door. You will go in the “IN” door, find your child and proceed to the “OUT” door where a security person will be checking the children out. You must have your matching wristband to pick up your child! Any questions? Please email [email protected] or call the TFH office at 707-­‐455-­‐7790 ext. 1581