Arts Camp Registration Payments of $10 ($20 max per family) can be dropped off or mailed to the church office at 4950 31st Ave NW, Rochester MN 55901. Please make checks out to Rochester Covenant Church.Child's Name* First Last Age*Grade in Fall 2018*Birthdate* MM DD YYYY Gender*MaleFemaleAddress* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Allergies*If none, please write "none" or "NA"Email Parent Name(s)* Main Phone*Mobile PhoneNon-Parent Emergency Contact Name*Emergency Contact Phone*Medical and Liability ReleaseWe realize that no activity is without the possibility of unforeseen hazards that could result in injury to an individual. As a parent or guardian, you are to be aware of your responsibility to instruct your child of the importance of conduct that will insure safety and an enjoyable time while participating in this activity. By signing this form, you, as a parent, guardian or other responsible party, agree to assume the risks and hazards that are inherent in this kind of activity. You also agree to absolve and hold harmless Rochester Covenant Church and other sponsoring organizations and their representatives for damage, loss, or injuries to the child for whom you sign. I further give my permission for the use of any photo or likeness of my child to be used by the sponsoring organizations for their use in promotional materials. I give my child (named below) permission to participate in this activity and give my permission to the leaders of this function to authorize any treatment deemed necessary by a licensed physician due to accident or illness during this activity.Agreement* I agree to this medical and liability release Name of Child* Signature*Enter your full name to sign this medical and liability release This iframe contains the logic required to handle Ajax powered Gravity Forms.