Pass It On Camp
  • Camp Registration Form

    Camp Registration Form

    These forms are required for your children to attend camp.

  • Camper's Information

  •  - -
  • Gender
  •  -

  • NOTE - Campers need to have completed Kindergarten before they are eligible to participate in our day camp.

  • Ethnicity Information

  • Parents' Information

    Parent/Guardian 1
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Parent/Guardian 2
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Home Address Same as Parent/Guardian 1?*

  • Medical / Health Information

  •  -
  • Is the Camper up-to-date on all immunizations?*
  • Does your child have any food, medication or environmental allergies?*
  • Allergies? Check all that apply*
  • 0/150
  • Does your child’s allergy/allergies require child care staff to monitor child for symptoms, take action if a reaction occurs, or give emergency medication to your child?*
  • Does your child have a special health or medical condition?*
  • 0/150
  • Does the special health or medical condition require child care staff to perform a procedure, or perform child specific care such as: to monitor your child for symptoms or administer medication during child care hours?*
  • Is your child currently using any medication, food supplement or medical food (such as electrolyte solution)?*
  • 0/150
  • If yes, does this medication, food supplement, or medical food need to be administered at the day camp?*
  • 0/150
  • 0/200

  • Additional Medication

  • Check all that apply
  • If your child's medication meets any of these criteria: A physician's instruction is needed for a nonprescription medication (e.g. child is underage or underweight per the label instructions); or It is a sample medication without a prescription label; or The nonprescription medication is to be given longer than three consecutive days within a fourteen day period or is a topical product or lotion that is being used for a skin ailment and is to be given no longer than fourteen consecutive days; or The child is on a modified diet (an entire food group is eliminated); or The medication contains codeine or aspirin. ***The topical product or lotion and the physician's instructions exceed the manufacturer's instructions or use  
  • Upload a File
    Cancelof

  • Field Trip Consent

  • As the parent or legal guardian, I certify and affirm that I have been completely and thoroughly informed that by attending this camp my child will attend Field Trips. I do not need to be informed of each and every activity or the Programs as I have a sufficient understanding of their general structure.

    I desire and do consent for my child to participate in the Field Trips with Pass It On. I consent to allow my child to be transported to and from the Pass It On Camp. I personally assume, on my child's behalf, all risk in connection with said Programs for any harm, injury, or damages that may befall my child as a result of my child's participation, whether foreseen or unforeseen, and I still wish to allow my child to proceed with the Program and Field Trips.

    By consenting below and signing this document, I acknowledge that if anyone is hurt or property is damaged during my child's participation in these activities, I may be found by a court of law to have waived my right to maintain a lawsuit against Pass It On or Marantha Church on the basis of any claim from which I have released them herein.

    I have fully informed myself of the contents of this PARENTAL CONSENT AND RELEASE FOR ALL ACTIVITIES by reading it before I consent. I warrant that I possess all the rights, powers, and privileges of a parent or legal guardian necessary to execute this document with binding legal effect.

  • Field Trip Consent and Release*

  • Disclaimers

    and Signature
  •  - -
  • Should be Empty: