ARC Interfaith Peace Camp
Friday May 24, 2013
Friday May 24, 2013
The Association of Religious Communities (ARC) Invites All To The
10th Annual Interfaith Peace Camp!
July 15th to July 19th, 2013
For children ages 8 to 11
Children will have fun making new friends as they visit five different sacred sites in our community, including a:
Camp includes lunches, healthy snacks and refreshments, all supplies for games, crafts and inter-active activities.
Fee is $50. (For scholarship waiver, phone Rev. P.J. Leopold at ARC 792-9450)
Each day, Campers will learn "What Peace Means" to a different world religion. Throughout the week, Campers share what peace means to them, as they explore fun, friendly ways to create peace with each other and in our great Danbury community.
Interfaith Peace Camp also provides opportunity for high school and college age students to work as Peer Leaders and gain experience as young leaders in the community. To inquire about being a Peer Leader, phone Rev. Leopold at 203-792-9450.
To Register !
Download the Registration Form and mail to:
ARC, 325 Main Street,
Danbury, CT 06810
Or
Fax to ARC at (203) 792-9452
Attn: Rev. P.J. Leopold.
Time
Each day of Camp
runs from
9:00am to 3:00pm.
You are here
~ Music ~
The below form is for informational purposes only. This form cannot be printed. To print
the
Peace Camp registration form, go to the top of the page and select "Peace Camp Registration"
on the "Peace Camp Links" drop-down menu.
Interfaith Peace Camp !
~ Registration - Children 8 to 11 years old ~
Return by mail to ARC, 325 Main Street, Danbury, CT 06810
Or by Fax to (203) 792-9452 (Att. Rev. Leopold)
A) Background
Child's name_______________________________ Birth Date_______________ Sex _____
Street___________________________ City__________________ State_____ Zip________
1st Parent/Guardian 2nd Parent/Guardian
Name________________________________ Name______________________________
Home Address (if different from child) Home Address (if different from child)
_____________________________________ ___________________________________
Daytime Phone_________________________ Daytime Phone_______________________
Email_________________________________ Email ______________________________
B) Activity Release
I, ______________________, hereby acknowledge that _____________________ is physically fit and
(your name) (child's name)
able to participate in Interfaith Peace Camp, which may include, but is not limited to sports, yoga, dance movements, games, cooking, or crafts. I am aware these activities may entail risks of injury and understand that ARC, camp facilitators, speakers, counselors, and participating religious communities will not be liable for any injuries, damages, etc.
C) Responsibility & Release Agreement
I, _______________________ accept full responsibility for my child _____________________
(your name) (child's name)
en route to and from Interfaith Peace Camp, and I agree to drop my child off at each
Interfaith Peace Camp site and to pick my child up from the site. Please send driving directions to me at the following address:
______________________________________ ________________________________ __________
(your street) (city) (zip)
The following 2 people are authorized to pick up and drop off my child. I understand
that s/he will not be released to any other persons without my written permission. I also understand that unless there is a court order to the contrary, both parents have legal authority to pick-up their child(ren) at any time. (Please include here only people who are not parents or legal guardian of the child.)
Name 1._______________________________ Name 2 _______________________________
Relation to child_________________________ Relation to child:________________________
Daytime Phone _________________________ Daytime Phone:_________________________
D) Medical Emergency
Child's name _______________________________ Birth Date________________ Sex_____
Emergency Contact:
Name ________________________________ Home Phone__________________________
Business Phone________________________ Cell Phone/Pager_______________________
Physician _____________________________ Phone_______________________________
Dentist _______________________________ Phone _______________________________
Health Insurance Carrier______________ Phone ___________ Policy #_________________
List any Allergies (food, meds, etc.) __________________________________________________________________________
List any Food Restrictions___________________________________________________
List any Medication and significant medical info_________________________________
I, _______________________, give ARC and/or camp facilitators permission to take whatever
(your name)
emergency measures (e.g. first aid, disaster evacuation) that are judged necessary for the care and protection of my child while under the supervision of ARC's Interfaith Peace Camp. In case of a medical emergency. I understand that my child may be transported to an appropriate medical facility either by a facilitator of ARC's Interfaith Peace Camp or by a local emergency unit if it is deemed necessary. Any expenses incurred will be my responsibility. I understand that in some medical situations, the local emergency resource may need to be contacted before either parent, the child's physician, and/or the other emergency contacts listed on this form.
E) Religious Affiliation
If you are affiliated with a faith community, please write the name of your religious affiliation or the name of your congregation: _____________________________________________________
F) Payment -- Please check one:
_____ My Registration Fee is in the mail ($50 check payable to ARC, and mail to 325 Main Street Danbury, CT 06810. In check Memo write "Peace Camp Registration").
_____ I would like Rev. Leopold to phone me, to discuss a Scholarship for all or some of the Registration Fee to be waived.
___________________________________________________ __________________
Signature of Parent or Guardian Date