2017 SUMMER CAMP AT THE MOUNT

Mount Pleasant Baptist Church 215 Rhode Island Avenue, NW • Washington, DC 20001 Tel: 202.332.5748 • Fax: 202.986.0531 • Web: www.mpbcdc.org

$125.00 per week per child includes meals and field trips. Children will enjoy academic enrichment, library time, swimming, and outings to museums, parks, science fairs and more. Extra Added This Year: There will be a science, technology and math focus

APPLICATION


CAMPER INFORMATION

PARENT/GUARDIAN ADDRESS WHERE CAMPER RESIDES

EMERGENCY CONTACT INFORMATION (when parent/guardian cannot be reached)

LIST ALLERGIES ABOVE (Include food, drugs or other)
MEDICAL RELEASE: (Please sign below) To my knowledge, my child is in good health and is capable of participating in a full sports program. In case of an emergency and when neither parent can be contacted by phone, I authorize the camp to take my child to