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ST George's Free To Be Me 2017 Registration
ST George's Free To Be Me 2017 Registration
2017
Evening Summer Camp
Saint Georges Episcopal Church Community Outreach Program
160 U Street, NW, WDC 20001
202-387-6421
202-387-9053 (fax) / churchofc@stgeorgesdc.org
Cooperate with rules and instructions of St. Georges staff in charge of activities. If necessary, I give St. Georges
staff permission to use their judgment in obtaining medical services for any serious injury sustained by my child
during participation in these activities. I give permission to the physician assigned to render medical treatment
deemed necessary and appropriate by the physician. I understand that St. Georges has no insurance covering such
medical or hospital costs incurred and, therefore, any cost incurred for such treatment shall be my sole
responsibility.
ALL PERSONS PARTICIPATING in the Free To Be Me Program are deemed to have waived all claims against
St. Georges Episcopal Church and its employees or representatives of the church and/or Diocese for injury,
accident, illness or death occurring as a result of participation in activities of the Free To Be Me Program.
Initialize _____
I give consent for the above child(ren) to attend this evening summer camp on the following dates:
Monday, August 14th through Friday, August 188h 2017 from 4:00pm to 8:00pm