TOR Summer Program

Trees of Righteousness (TOR) Summer Program Registration

Turning Point Ministries Church, 7245 East Lawn Drive, 45236, 513-731-7245

Student Information

Name:

First

Last

Gender:

Male

Female

Address:

Street AddressStreet Address Line 2CityState / Province / RegionPostal / Zip CodeCountry

Birth Date:

Grade Entering in Fall:

Program Cost:

Family of 1 child: $25.00 / week ; 3 weeks- $75.00

Family of 2 or more children: $50.00 / week ; 3 weeks- $150.00

Parent 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 Info

Emergency 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 Confirmation

Parent E-mail (camper confirmation will be sent by email. if left blank, it will be mailed):

Additional E-mail:

Other Information

How did you hear about TOR Summer Program?

First Time Attending TOR?:

Yes

No

Health Information

Preferred 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?

Yes

No

Date 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 Release

Does the TOR program have permission to use photos of your child in educational or promotional material? (There is no cost)

Yes

No

Do you or a family member attend Turning Point Ministries Church?

Yes

No

If so, what is their name?

Does your child attend the church's "Children Church" program?:

Yes

No

If 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 Card

Check (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, 2017

Be 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: