By signing my name below, I do hereby authorize the Woodstock Evangelical Covenant Church to seek emergency medical care for my child(ren) in the event of injury, accident or illness. I give my son/daughter permission to attend Great Escape with WECC June 26-28, 2018.

Parent's Name (required)

Days/Activities Registering for (registration for each day must be received at least 24 hours ahead)
Tuesday - Mini Golf and Ice CreamWednesday - Bowling and PizzaThursday - Lake Compounce

Child's Name (required)

Grade entering in the fall (required)

Street Address (required)

City/State/Zip Code(required)

Phone Number (required)

Parent's Email (required)

Emergency Contact Name 1 (required)

Emergency Contact Phone 1 (required)

Emergency Contact Name 2 (required)

Emergency Contact Phone 2 (required)

Allergies (required)

Physical Limitations or Special Needs(required)

May we have your permission to photograph your child? (required)
YesNo

Any additional information?

How did you hear about our Great Escape program?

If registering for all three days, the cost is $50 and you can pay online (below) or bring cash/check. You may also use the online payment form to pay for Lake Compounce ONLY. If your child is not attending all four days or you choose to pay on a day by day basis, please send cash/check with your child.

If paying online, please click send below before moving on to the payment step. Your registration will not go through unless you hit SEND below.

 
PLEASE MAKE SURE YOU CLICK THE SEND BUTTON ABOVE BEFORE COMPLETING YOUR PAYMENT.