Camp Registration Form

Camp Registration Form

REGISTRATION: Please complete one form for each camper and submit. Once submitted, go to the next step to make payment. You can make an all-in-one-time payment (allowing $46 per camper). This will secure your reservation for camp. Email us at info@LibertyCampForKids.com if you have any questions, need help in completing the form, or need financial assistance. We will reply as soon as possible.
Camper's Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Grade entering this fall*
Gender*

MaleFemale
Age*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Parents' Name(s)*
Food/Health Allergies*
List all or enter "none"
T-Shirt Size*

Childrens XS (4-6)Childrens S (6-8)Childrens M (10-12)Childrens L (14-16)Adult SAdult MAdult LAdult XL
How did you hear about Liberty Camp for Kids?*

Friend/Neighbor/RelativeWebsiteFacebook/Social MediaMagazineRadio/Newspaper
Friday Picnic

We have a Friday picnic beginning at 12:15. Parents and siblings are invited. The main course and lemonade will be provided. (You are welcome to bring a different beverage for your family.) Parents attending are requested to bring another item that will serve 6-8. A final signup sheet will be displayed at registration on Wednesday. Then you will make your final reservation and/or selection. Please be sure to bring a picnic blanket. (Your final count should include all members, even campers.)
Friday Picnic*

SaladFruitSnackDessertNot able to attend
Number attending the Friday Picnic (Camper/s included)*
Enter 0 or "none" if not attending
Release Authorizations
Photo/Video Release Form

I hereby authorize the Liberty Camp for Kids to take pictures and videos, reproduce and/or publish all written and/or visual materials that are made during Liberty Camp for Kids events, including photographs and videos that may pertain to me or my children. This material may be used in publications, public affairs releases, social media, or recruitment materials. This authorization is continuous and may only be withdrawn by my specific recession of this authorization. Liberty Camp for Kids may publish materials, use my name, my child's name, photograph, video, and/or refer to me or my child in any manner that the Liberty Camp for Kids deems to promote/publicize the event. Approval is required to attend camp.
Agree?*

I agreeI disagree
Liability Authorization

APPROVAL IS REQUIRED FOR ATTENDANCE AT CAMP. The undersigned hereby request and approve entrant's registration and participation in the Liberty Camp for Kids. In consideration of such registration, the undersigned hereby agree that entrant's participation will be at the sole risk of entrant and the undersigned without liability to the Liberty Camp for Kids and their officers, members, and agents, all of whom the undersigned hereby agree to release, indemnify, and hold harmless from any and all claims and expenses resulting form or relating to entrant's said participation.
Agree?*

I agreeI disagree
Should be Empty:

Camp Registration Form

Release Authorizations