Camp Creation Registration

Camp Creation will be August 10, 2022

9:00AM - 1:30PM at the Kiwanis Youth Cabin.

Cost is $5.00 per child, this includes supplies and lunch.

You are responsible for your child's transportation

both to and from the Youth Cabin.

Children must be of Kindergarten age and above to participate in camp. Please fill out this form separately for each child attending.

Child's Name *

First Name Last Name

Grade *

Does this child have any food allergies, medical conditions or special needs? *

Yes No

Please list all food allergies, medical conditions or special needs below. (be specific)

Your child may be photographed periodically during Camp Creation. These photos are occasionally used during worship or for publicity purposes. Identifying information (including name) is never used for publicity purposes. Please indicate below your permissions regarding the use of photos of your child. *

Allow photo use DO NOT allow photo use

Parent/Guardian Name *

First Name Last Name

Phone Number *

Please enter a valid phone number.

Parent/Guardian Name

First Name Last Name

Phone Number

Please enter a valid phone number.

Home Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Email *

example@example.com

Additional Emergency Contact *

First Name Last Name

Relationship to Child *

Emergency Contact Phone Number *

Please enter a valid phone number.

By signing your name below you verify that you are completing the registration on behalf of the minor listed above, and are the parent/guardian whom has authorization to submit this registration for this child. *

Clear