Kids' Camp Registration

Primary Parent/Guardian Info

Best contact mobile phone

Do you agree to receive information by text message?

Yes No

Best contact email (this email receives confirmation information)

This address will receive a confirmation email

Address

Additional Parent/Guardian or Emergency Contact Name/relationship

Emergency Contact Phone Number

Please list the Name(s), Date of Birth (DOB), T Shirt Size, Gender and any allergies, sensitivities and/or special needs for each Youth attending (see examples).

Example youth #1 Example youth #2
Shirley Temple   Roy Rogers
Female Male
Youth Small Youth Medium
04/23/2021   11/05/2015
Nut allergy   Gluten Free

YOUTH 1: Name, Date of Birth (DOB), T Shirt Size, Gender and any allergies, sensitivities and/or special needs.

YOUTH 2: Name, Date of Birth (DOB), T Shirt Size, Gender and any allergies, sensitivities and/or special needs.

YOUTH 3: Name, Date of Birth (DOB), T Shirt Size, Gender and any allergies, sensitivities and/or special needs.

YOUTH 4: Name, Date of Birth (DOB), T Shirt Size, Gender and any allergies, sensitivities and/or special needs.

Agreement: I have read and fully understand this liability waiver and release form. I voluntarily agree to its terms and conditions.

Acknowledgment of Risk: I, the undersigned, understand that participation in [Camp Name] involves inherent risks, including but not limited to physical injury, illness, and property damage. I acknowledge that these risks may arise from the activities them Release of Liability: In consideration of being allowed to participate in [Camp Name], I hereby release, waive, and discharge [Camp Name], its officers, directors, employees, volunteers, and agents from any and all liability, claims, demands, actions, and Medical Authorization: I authorize [Camp Name] to obtain medical treatment for my child in the event of an emergency. I understand that I will be responsible for any medical expenses incurred. Indemnification: I agree to indemnify and hold harmless [Camp Name], its officers, directors, employees, volunteers, and agents from any and all claims, demands, actions, and causes of action, including attorney's fees, arising out of or related to my chi Photo/Video Release: I grant [Camp Name] permission to use photographs and/or video recordings of my child taken during camp activities for promotional purposes, including but not limited to social media, websites, and printed materials.

Anything else you would like us to know?

Description

June 23 - 27 3:00 to 7:00 pm

Please fill out this form and click submit.

Kids' Camp Registration

Description

Please Fix the Following