His Place Summer Camp Registration - Camps are $15

Please select one or more:

ARTrageous Kids - July 12-15 at 9:00-11:00am. 1st-3rd graders (as of fall '10)

ARTrageous Kids - July 12-15 at 12:00-2:00pm. 4th-6th graders (as of fall '10)

Basketball - June 28th - July 1st at 9:00-11:00am. 7-10yrs.

Basketball - June 28th - July 1st at 12:00-2:30pm. 11yrs and up

Child's Name :

Child's Age:

Parent Name:

Email:

Phone:

Mailing Address:

Waiver: By submitting this form, I am declaring that I understand that inherent in this activity is the potential for injury. Since every reasonable effort has been made to insure that safety & integrity of the facilities, I understand that His Place and staff will not be held liable for any loss or injury related to my child’s attendance. I also give permission for my child’s photo to be used for advertising purposes. Please select one:
YES
NO

Your Message:
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