Messengers Kids Camp 2023

Camp Hours 9am-4pm

PreK-K 9am-1pm
Parent/Guardian Information
Parent's Name*

First NameLast Name
E-mail*
example@example.com
Cell Number*
Relationship to Applicant*
Camper Information
Please provide info according to each camper*
Emergency Information
Emergency Contact Name*
First and Last Name
Emergency Relationship to Applicant*
Emergency Contact Phone Number*
Additional Information
Does your camper have any allergies, chronic illness, or medical conditions? If yes, please describe.
How did you hear about us? *
Are you interested in coming to our Family Festival on July 22nd?
FREE event! Invite anyone :)
Applied Date*

MonthDayYear
Date
Program*
Lead Status*
Jotform Integration*
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by YWAM Kansas City during the selected camp. In exchange for the acceptance of said child’s candidacy by YWAM Kansas City, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless YWAM Kansas City and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against YWAM Kansas City including all volunteers and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all activities. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.
Medical Release and Authorization

My child has volunteered to participate in YWAM Kansas City's Messenger Kids camp. I recognize participation in the camp may be hazardous or dangerous. Therefore, I, as a parent/guardian of the participant, am releasing and forever discharging Youth With A Mission and all individual/organizations associated with the camp, from any and all claims, reason of injury, damage (including property damage to any of my child's belongings), loss or death which may occur from any cause including, but not limited to, any accident and/or occurrence while participating individually or with others during the camp.

I give permission to Youth With A Mission Kansas City for my child to participate in the YWAM Kansas City Messenger Kids Camp. I understand that reasonable precautions will be taken to safeguard the health and well-being of the participant, and that parent/guardian will be contacted immediately in the event of an emergency. In case of sickness or accident, I authorize and consent to any x-ray exam, anesthetic, dental, and/or medical treatment and hospital care to be rendered to my child under the general care and advice of any physician, dentist, and/or surgeon licensed to practice medicine. I further consent and authorize the leader(s) of the camp to seek immediate emergency medical treatment at a facility he/she deems appropriate if necessary.

I, as a parent/guardian of the YWAM Kansas City Messenger Kids camp participant, authorize Youth With A Mission Kansas City (including sister ministries and related entities) to take and use photographs and videos of my child for educational and/or promotional purposes in any type of media, including its website. I agree that the photographs and videos may be used with or without my child's name. I understand that I or my child will not be paid or rewarded for providing this authorization.

I release and consent Youth With A Mission Kansas City of the categories above, Release of Liability/Consent, Medical Release, and/or Media Release.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date*

MonthDayYear
Date
Signature*

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Camp Payment (SELECT WHICH TICKET & HOW MANY CAMPERS ARE REGISTERING) *

Preschool/Kindergarten Class (9am-1pm) PLEASE SELECT NUMBER OF CAMPERS REGISTERED BELOW

$120.00 Quantity

Family BundleFOR FAMILIES WITH 2+ CAMPERS, $160 PER CAMPER

$160.00 Quantity

General AdmissionPLEASE SELECT NUMBER OF CAMPERS REGISTERED BELOW

$180.00 Quantity
Item subtotal:$0.00

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Total

$0.00

Payment Methods

Debit or Credit Card

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Camp Hours 9am-4pm