Trees of Righteousness (TOR) Summer Program RegistrationTurning Point Ministries Church, 7245 East Lawn Drive, 45236, 513-731-7245Student InformationName: First Last Gender:MaleFemaleAddress: Street AddressStreet Address Line 2CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiComorosCongo (Brazzaville)CongoCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMoroccoMozambiqueMyanmarNamibiaNauruNepaNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabweCountryBirth Date:Grade Entering in Fall:Please Select Camp Week:Week 1: June 19-23Week 2: June 26-30Week 3: July 3 - 7June 19 - June 30June 19 - July 7Program Cost:Family of 1 child: $25.00 / week ; 3 weeks- $75.00Family of 2 or more children: $50.00 / week ; 3 weeks- $150.00Parent or Legal Guardian Information:Parent or Guardian Name: First Last Relation:Work Phone: Area Code - Phone Number Cell Phone: Area Code - Phone Number Home Phone: Area Code - Phone Number Parent / Guardian 2 Name: First Last Relation 2:Work Phone 2: Area Code - Phone Number Cell Phone 2: Area Code - Phone Number Emergency Contact InfoEmergency Contact Name (if parent or guardian is not available): First Last Emergency Phone: Area Code - Phone Number Emergency Phone 2: Area Code - Phone Number Email ConfirmationParent E-mail (camper confirmation will be sent by email. if left blank, it will be mailed):Additional E-mail:Other InformationHow did you hear about TOR Summer Program?First Time Attending TOR?:YesNoHealth InformationPreferred Hospital:In the event of an emergency, your child will be taken to the nearest hospital. Turning Point Ministries is not responsible for emergency and transportation costs. You will be notified immediately at the phone number provided.Are immunizations up to date?YesNoDate of last Tetanus Shot:Any activity the TOR Participant should be restricted from:Any physical, mental, or other condition that would require special attention or medication while at camp?List all medications, both prescribed and over the counter. All medications will be turned into the health officer except rescue inhalers, bring all medication in original containers.List any allergies (bees, peanuts, dairy, etc):Any dietary needs we should know about?TOR Program Photo ReleaseDoes the TOR program have permission to use photos of your child in educational or promotional material? (There is no cost)YesNoDo you or a family member attend Turning Point Ministries Church?YesNo If so, what is their name?Does your child attend the church's "Children Church" program?:YesNoIf so, what is the child's name?Payment Information$25.00 per week ($75.00 for three weeks); Families with two or more children - $50.00 per week ($150.00 for three weeks); Program capacity - 50 students. To guarantee a space, full payment is necessary.Method of Payment:Credit or Debit CardCheck (mail to address at top of form)Cash (see instructions below)If using a credit or debit card, payment can be made through PayPal located on the church website (www.tpmpc.org). Payment by cash - on site (10:00am - 12pm) every Saturday beginning May 20, 2017 - June 10, 2017Be certain to enter your email address correctly on the registration form to receive confirmation via email within 1 week.I understand that in order for my child to attend the TOR Summer program, a registration fee of at least one week ($25.00 for each individual child or $50.00 for a family with 2 or more children) must accompany this form. By hitting submit and putting your initials below, you agree that you are the parent or legal guardian of the above named camper(s), and are over the age of 18. In case of medical emergency or general medical care, I give consent for medical treatment for the above named TOR participant by authorized personnel. The program carries liability insurance. I understand that the above named TOR participant will only be released to the names listed above. An update may be done at registration. I certify that my child has my permission to attend camp and participate in all activities. We have limited space, therefore, payment of all three weeks guarantees a space for you.ELECTRONIC SIGNATURE. PLEASE INITAL:SubmitReset