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Fill out the form below to add additional campers if you've already completed
this form
for one of your children.
*
Indicates required field
Parent/Primary Guardian Name
*
First
Last
Camper Information
Camper Name
*
First
Last
Birth Date
*
Gender
*
Church Group
*
T-Shirt Size
*
Children's Small
Children's Medium
Children's Large
Children's XL
Adult Small
Adult Medium
Adult Large
Adult XL
Adult XXL
Drop Off/Pick Up Information
*
Is allowed to walk home
Is allowed to be picked up by parent/guardian or emergency contacts
Program Attendance
Camp Noah will begin at 9:00am each morning and ends at 5pm on Monday - Friday
Days able to attend program
*
Monday
Tuesday
Wednesday
Thursday
Friday
Arrival Time
*
On Time
15 minutes late
30 minutes late
more than 45 minutes late
Medical Information
Please fill out the section below as thoroughly as possible to help us best serve your child.
If your child has any allergies, enter them in the text box. If not, type N/A
*
If your child were to come in contact with their allergen, how would you deal with the situation? If your child does not have any allergies, type N/A.
*
What medications does your child take? If none, type none.
*
What special needs (medical conditions, disabilities, learning issues) does your child have? If none, type N/A
*
Other Information
Will Your Child Be Attending Summer School?
*
Yes
No
What Days/Times
*
Grade in 2022-2023 Year
*
Will your child miss any days of camp that you already know about?
*
Additional Comments
*
Permissions & Agreements
Prior to your child starting program, you will be asked to sign the following agreements.
I give my permission to the school district to release my child's records to Hartford City Mission.
I understand my child may be photographed or recorded on video to be used for memorabilia and program promotion. You have my permission to photograph and videotape my child or display samples of his/her work.
I understand that my child may need to be transported to various sites within the state of Connecticut for field trips and other programmatic events. Children will only be transported by licensed staff. I give Hartford City Mission staff and/or volunteers permission to transport my child for program activities and release the staff and/or volunteers from any liability.
By hitting the submit button below you are acknowledging agreement with the following statements
:
I understand that placement in this program is not guaranteed and space is limited.
I understand that in order for a child to have an excused absence, I must inform the program by 8:30am.
I understand Hartford City Mission reserves the right to remove students based on conduct and/or attendance.
I understand that I am responsible for my child's transportation to and from program.
I understand that Hartford City Mission's programs use lessons that are Biblically based and my child will be exposed to and participate in Christ-centered activities.
I understand that my registration is not complete until all paperwork has been completed and submitted including a physical dated within the last 2 years.
Submit
Home
About
About HCM
History
Leadership
The Board
Programs
All Programs
Children (Grds. K-8)
Youth (Grds 9-12)
Connect
Contact Us
Volunteer
>
Volunteer Interest Form
Donate
Donate to HCM
Legacy Gifts