Camp Noah Registration

***If you are intending to sign up for Noah or Nehemiah After School follow this link:
https://hartfordcitymission.org/after-school-registration.html ***

Camp Noah is a 6 week summer day camp that consists of character development in a safe and fun family atmosphere. Daily activities include friendly competitions, crafts, Biblically-based character development lessons based on the life of Jesus, and healthy snacks. Camp Noah 2021 runs from July 12 - August 20, from 9:30 - 5:00 PM. For more info on camp please contact our office.

Fill out the form below to start the registration process for Camp Noah.

Please note that after you complete this form, you will receive an email with next steps which include completing this form for each child you would like to register, giving us a physical copy of each child's most recent physical (Completed on or after 8/31/2018), and attending an orientation.

You must complete this form for each of the children you are registering.
Be sure to indicate the program for which you are registering them.

Parent or Primary Guardian Info

* Indicates required field

Parent/Primary Guardian Name *

First

Last

Parent/Primary Guardian Email *

Parent/Primary Guardian Phone *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Camper Information

If you have more than one student, you don't have to fill out the whole form multiple times. Once you submit this form for one student, you can click here (this link will pop up after submitting) for additional students.

Camper Name *

First

Last

Birth Date *

Gender *

Church Group *

T-Shirt Size *

Drop Off/Pick Up Information *

Is allowed to walk home Is allowed to be picked up by parent/guardian or emergency contacts

Program Attendance
Beginning in 2021, Camp Noah will begin at 9:30am each morning and ends at 5pm on Monday - Friday.

Arrival Time *

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 *

Will Your Child Be Attending Summer School? *

Yes No

What days/times? *

Grade in 2021-2022 year *

Will your child miss any days of camp that you already know about? *

Emergency Contact Information

List 2 emergency contacts that are NOT the parent or primary guardian.

Emergency Contact 1

Name (EC1) *

First

Last

Phone Number (EC1) *

Relationship to Child (EC1) *

Emergency Contact 2

Name (EC2) *

First

Last

Phone Number (EC2) *

Relationship to Child (EC2) *

Comment *

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 3pm.
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

You must complete this form for each of the children you are registering.
Be sure to indicate the program for which you are registering them.

Fill out the form below to start the registration process for Camp Noah.

Parent or Primary Guardian Info

Camper Information

Emergency Contact Information

Permissions & Agreements

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