heART and SOUL Registration

heART and SOUL: A summer week IN THE SPIRIT 2021

ONLINE REGISTRATION AND PERMISSION FORM
Download Printable Version of Registration Form

heART and SOUL is a week long Arts & Spirituality Day Camp for Young People who have completed Grades 1-8. We will meet daily Monday, August 9- Friday, August 13 from 9 a.m. – 2 p.m. (with optional before and after activities – drop off as early as 8 a.m., pickup as late as 3 p.m.) ENROLLMENT IS LIMITED AND ON A FIRST COME/FIRST SERVE BASIS, so please register early. Registration DEADLINE is Wed. JUNE 30. You may use the same form for more than one child. If your child has any special diet restrictions, please let us know at the time of registration. We are offering this program FREE of charge and program includes lunch and snacks. There is a Refundable $30 REGISTRATION DEPOSIT that will be returned to you on the 1st day of attendence. If you have questions, please call Rev. Scott Myers at (816) 931-1032 or email info@westportpresbyterian.org

Step 1: Pay Refundable $30 Registration Deposit

You can pay securely online using the button below with a debit, credit card or electronic transfer from your bank account (e-check). Your deposit will be refunded on the first day of attendance.

Step 2: Submit Registration Information

Please complete the form below and hit the submit button to finish the online registration process.

Child's Name(required)

Age(required)

Grade(required)

2nd Child's Name

Age

Grade

Address, City, State, Zip(required)

Parent(s) or Guarian(s) Name(s)(required)

Email(required)

Home Phone

Work Phone

Cell Phone

Alternative Person to notify in case of emergency(required)

Alternative Person's Phone(required)

Relationship to Child(required)

Child's Doctor's Name(required)

Doctor's Phone(required)

Allergies or Dietary Restrictions (if any)

Operations/Injuries/Other Important Medical Info

Medicine(s) Currently Taking

In case of medical emergency, I understand every effort will be made to contact a parent or guardian of the child, or alternative person listed. In the event none of these can be reached, I hereby give permission for a physician selected by the church to secure proper treatment for, hospitalize, order injection, anesthesia or surgery for my child(ren) as named above.(required)

Parent's E-Signature(required)

Date(required)