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4th-6th Grade Overnight
Child Info
Child Name
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Children.
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Maximum number of children reached.
OPTIONAL: Invited by a friend? Tell us who invited you!
Address
Street Address
City
State / Province / Region
ZIP / Postal Code
Parent Name (#1)
(Required)
First
Last
Parent Phone (#1)
(Required)
Parent Email (#1)
(Required)
Parent Name (#2)
First
Last
Parent Phone (#2)
Parent Email (#2)
Insurance Company
(Required)
Policy Number
(Required)
Group Number
Sunday Pick Up Options
(Required)
Pick up at playground at 8:45AM
Attend Sunday School at 9AM and pick up at 10AM at playground
Sunday School at 9AM and meet parent in church at 10:15AM
Sunday School at 9:00 AM and attend Children’s Chapel. Meet parents in church at the announcements.
Pick Up Individuals
If someone other than a parent is authorized to pick up your child, please add them here.
Name
Actions
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People.
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Maximum number of people reached.
Bedtime Rules
(Required)
Please review these with your child carefully before submitting.
I will respect and stay in my bed when asked
Leaders understand that you may need to use the restroom, but that should be once and by yourself.
I will not talk and be disruptive to those around me during sleeping time.
I will not wake others up who are asleep.
In the morning, I will get up when asked and get ready right away.
Agreement of Permission
(Required)
I give permission for my child(ren) to attend the 4th-6th grade overnight at Saint Barnabas.
I direct the adult leadership to authorize such medical care for my young person as is deemed necessary in an emergency.
I give permission for photo release to be used for Saint Barnabas purposes only.
I understand that if my child(ren) do not follow the rules, I will be called and asked to pick them up.
I give permission for my child(ren) to be driven by the leaders if necessary.
Electronic Signature
(Required)
I certify that by typing my name below in the Electronic Signature Field and submitting this form, I intend to sign this document and be bound to the same extent as if I had provided a physical signature.
Child Name
(Required)
First
Last
Gender
(Required)
Male
Female
Other
Birthdate
(Required)
MM slash DD slash YYYY
Dietary
Gluten Free
Dairy Free
Vegetrarian
Vegan
Select All
Other Food Allergies
Known Medical Conditions
Medications, if any
Evening
Bedtime
Morning
Medication Name and Dosage
Name
(Required)
First
Last
Relationship to Camper
(Required)
Phone
(Required)