July 22-26 / 9am - NOON / FREE / JK - GR 5

Camper Name: *
Camper Name:
Specific what grade your child is entering in the fall.
Address: *
Parent/guardian Name: *
Parent/guardian Name:
Cell Phone: *
Cell Phone:
Emergency Contact *
Emergency Contact
(if parent/guardian cannot be reached)
(list all possible choices) Photo ID is required for pickup
Please list all your child(ren)'s allergies, medications, & special needs. ***PLEASE NOTE, on the first day of camp, the parent/guardian will be required to fill out a medication consent form. Parkway staff and volunteers will only administer medication upon completion of this form, and with properly labelled medicaiton by Pharmacy with the child's name and dosage.
Medical Release *
I hereby consent to the participation of my child in all Parkway Church summer camp activities. While every precaution is taken for the safety and good health, some activities carry with them the inherent risk of personal injury beyond the risks associated with many of the recreational activities at Parkway. I/we understand and accept these risks and agree that by allowing my child to participate in those activities, he/she may be taking part in a recreational activity that presents the potential for personal injury. I/we the parents or guardians named above, authorize the Pastor or one of Parkway ministry 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, named above, undertake and agree to indemnify and hold blameless Parkway Church and its personnel, it's Pastors and Board from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of Parkway Church and as well as of any medical treatment authorized by the supervising individuals representing Parkway Church. This consent and authorization is effective only when participating in or traveling to events of Parkway Church. In the case of possession of dangerous items or non-compliant behavior, at the discretion of the staff, parents/guardians will be contacted and required to pick up their child immediately.