Name of Participant *

First Name

Last Name

Name of Additional Participant

First Name

Last Name

Name of Additional Participant

First Name

Last Name

Parent/Guardian's Name *

First Name

Last Name

Parent/Guardian Cell Phone *

(###)

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Parent/Guardian Phone (other)

(###)

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Emergency Contact Cell Phone *

(###)

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Emergency Contact Phone (other)

(###)

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Photo Release *

I hereby give permission for the above named participant(s) to be photographed during summer camp. I understand that these untagged photos may appear in newsletters, on the FPCLG website and/or on FPCLG Facebook and Instagram and that children will NOT be named in any photo posted on the FPCLG website or on social media.

PARENT/GUARDIAN PERMISSION *

By selecting the "I Accept" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting "I Accept" you consent to be legally bound by this Agreement's terms and conditions. The above-named participant(s) has/have my permission to engage in the events described above. In consideration of the benefits derived from participation, I hereby voluntarily waive any claim against First Presbyterian Church, La Grange, Illinois 60525, or its staff or volunteers for any and all causes that may arise in connection with this activity. In case of serious accident or illness emergency, we hereby give permission to the adult advisors to secure proper treatment for our children as named above.

I ACCEPT

Date *

MM

DD

YYYY