" 2011 SUMMER DAY CAMP"

INFO AND REGISTRATION FORM

DATES:  June 13th thru July 8th   -   Monday thru Friday

TIME:     8:30 AM  -  light breakfast  -  9:00 AM  Programming starts

                11:00 AM -  Day Camp Ends every day

WHERE:  Creston Community Park, MURRAY HALL building

COST:  FREE 

The Creston Community Service Club is sponsoring this SUMMER DAY CAMP program for children between the ages of 5 and 12.  Our goals are to have activities that will stimulate the mind, have fun, get exercise, interact with other children, and enjoy some food.  It is the responsibility of the parent/guardian to transport the child/children to the park each morning and to pick them up promptly at 11:00 AM.

If you are interested in having your child/children attend Summer Day Camp, please fill out and return the form below as soon as possible.  We would like to get a count of how many children will be attending the camp so we will have an idea of how much food and supplies we need.  Remember the cost of this camp is FREE.

Send the completed form to -  Creston Community Service Club, c/o H. Uhler, 105 Coulter Street, Creston, OH  44217 

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Child's Name ______________________________________________________________Birthdate_____________________Age_______

Address __________________________________________________________________________________________________________

Father's Name & Address ___________________________________________________________________________________________

Mother's Name & Address ___________________________________________________________________________________________

Father's Phone # _________________________________________  Mother's Phone # _________________________________________

Emergency Phone # of a relative or neighbor _____________________________________ Name _________________________________

I hereby grant permission for my child/children to participate in the Creston Community Service Club Summer Day Camp program, fully realizing that any of it's supervisors or members of the organization may not be held liable for any injuries resulting from an accident in conjunction with this program.

_________________________________________________                            _____________________________

              (Signature of Parent / Guardian)                                                                    (Date)