WAPAC Kids Camp Registration 2022

Form 1 of 3

You are registering your child for WAPAC Kids Camp at Miracle Ranch for July 11th - 15th, 2022. You will need to fill out one complete form for each child attending. Please be careful to fill in all required fields before hitting submit. This will expedite your registration process and help to reduce errors in submission which may require you to start the form over. There are three forms that need to be completed before registration is finalized. The three forms are:

WAPAC Kids Camp Registration

WAPAC Medical Release and Information

Crista Waiver and Release

Once you have finished the first form and click submit, you will be directed to the next form. Thank you for taking the time to complete this form, we look forward to ministering to your child at camp.

WAPAC Kids Camp Registration

Childs Full Name *

First Name Last Name

Gender *

Male Female

Age *

Birthday *

Grade Entering 2022/2023 *

T - Shirt Size *

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Church you are attending with *

Parent's E-mail *

Confirmation Email example@example.com

Parent/Legal Guardian Name *

First Name Last Name

Parent/Legal Guardian Cell / mobile Phone # *

Area Code Phone Number

Parent/Legal Guardian Name

First Name Last Name

Parent/Legal Guardian Cell / Mobile Phone #

Area Code Phone Number

With Whom do you live *

CAMP RULES OF CONDUCT:

We expect each child to conform to these rules of conduct: No possession or use of alcohol, drugs, or tobacco. No fighting, weapons, fireworks, lighters, or explosives. No offensive or immodest clothing. No electronics (cell phones, ipods, video games) Participation with the group is expected. Respect property, respect one another, staff, and adult leaders. Respect and comply with event schedules. Girls and boys cabin areas are to be respected, boys will not enter the girls cabin area, girls will not enter the boys cabin area. Children who fail to comply with these expectations may be sent home at their parents’ expense. I, the participant, have read the rules of conduct and agree to abide by the stated personal limitations and code of conduct.

Child Full Name *

First Name Last Name

Check here for your electronic signature acknowledging the rules of conduct above *

I acknowledge the above rules of conduct.

Activities may include, but are not limited to: cookouts, swimming, basketball, games in the field, soccer, volleyball, softball, baseball, camping, hiking, bible studies, paintball, horseback riding, ropes course, archery. Note: If you desire to limit your child’s participation in any event, please submit your wishes in writing to your local church camp coordinator and camp counselors.

Childs name *

The above listed child has my permission to participate in all camp activities sponsored by the Washington Pacific District Church of the Nazarene from July 11, 2022 through July 15, 2022. This consent form gives permission to seek whatever medical attention is deemed necessary, and releases the Washington Pacific District Church of the Nazarene and its representatives of any liability against personal losses of named child. I/We the undersigned have legal custody of the child named above, a minor, and have given our consent for him/her to attend events being organized by the Washington Pacific District Church of the Nazarene. I/We understand that there are inherent risks involved in any ministry or athletic event, and I/we hereby release the Washington Pacific District Church of the Nazarene, its pastors, employees, agents, and volunteer workers from any and all liability for any injury, loss, or damage to person or property that may occur during the course of my/our child’s involvement. In the event that he/she is injured and requires the attention of a doctor, I/we consent to any reasonable medical treatment as deemed necessary by a licensed physician. In the event treatment is required from a physician and/or hospital personnel designated by the Washington Pacific District Church of the Nazarene, I/we agree to hold such person free and harmless of any claims, demands, or suits for damages arising from the giving of such consent. I/We also acknowledge that we will be ultimately responsible for the cost of any medical care should the cost of that medical care not be reimbursed by the health insurance provider. Further, I/we affirm that the health insurance information provided above is accurate at this date and will, to the best of my/our knowledge, still be in force for the child named above. I/we also agree to bring my/our child home at my/our own expense should they become ill or if deemed necessary by the WAPAC Kids Camp team.

Parent / Legal Guardian Name *

Date *

Electronic Signature *

checking this box signifies my acknowledgement of the above Camp Release and Liability information as well as signifies my electronic signature here for the above listed name

Washington Pacific District Church of the Nazarene may publish photos and/or videos taken of participant and I release all rights to remuneration for such photos and/or videos. I hereby certify that I am 18 years of age; I have carefully read the foregoing and acknowledge that I understand and agree to all the terms and conditions. I have had the opportunity to ask any and all questions regarding this Agreement and the effect of the same. I am aware that by signing this Agreement, I assume all risks and waive and release certain substantial rights that I have or possess.

Participant signature: (on behalf of marital community) *

DATE *

Electronic Signature *

checking this box signifies my acknowledgement of the above Photo/Media Release information as well as signifies my electronic signature here for the above listed name

You will automatically be directed to the WAPAC Medical Release Form 2019 when you push submit. You will need to fill out the next two forms to be fully registered for camp.

My Products

Early Bird Registration $ 330.00

Enter coupon

Total $ 0.00

Credit Card

Camp Release

Photo/ Media Release

Credit Card