Summer Camp Registration

Summer Camp Registration

Use this form to sign up for 2023 Summer Camps at Kingdom. One form per junior camper; those with multiple campers will need to fill out multiple forms. Each camp has camper limits, you will receive an email confirmation when our sign ups are finalized.
Parent/ Guardian Name

First NameLast Name
Email
example@example.com
Member Number
Phone Number
Please enter a valid phone number.
Campers Name

First NameLast Name
Campers Age
Is there anything we should know about your Camper? (allergies, health, if no please type N/A)

Day Camps
Ages 14 & Under, $150 per Week, $600 all 4 weeks

It’s a great time to plan for your child’s time off from school. Camp is the perfect choice. Camp meets Monday through Friday. Your child will get to spend his or her days surrounded by camp friends, laughing and playing, all under the watchful care of our talented and responsible staff. Our program will consist of a combination of outdoor adventures, arts and crafts, fun with foods, team building, super science projects, group games, camp traditions and more.
Which Camp weeks would your camper like to attend?

Week 1 -> July 3-7 *The Great OutdoorsWeek 2 -> July 10-14 *Money MattersWeek 3 -> July 17-21 *Discover your path (Careers week)Week 4 -> July 24-28 *Game On! Sports Week

Medical & Emergency Contact Form
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Emergency Contact 1

First NameLast Name
Emergency Contact #
Please enter a valid phone number.
Emergency Contact 2

First NameLast Name
Emergency Contact #
Please enter a valid phone number.
Insurance information:
Insurance Company:

Policy#
Policy holder’s Name (Parent/Gaurdian)
Medical Information:
Medications presently taking:

PrescriptionNon Prescription
I give my child permission to self administer their prescription medication (circle):
Y N/
I give my child permission to self administer their prescription medication (check)

YNOther
I give my child permission to self administer their non prescription medication:
Y /N
Drug sensitivities/allergies
Epi-pen: Does your child require an epi pen to treat an allergy? Y N. If so please speak with the camp director at registration.
Y/N
Epi-pen: Does your child require an epi pen to treat an allergy? Y N. If so please speak with the camp director at registration.
Y/N
ALL camp activities. Initial_______________ Tetanus ___________
Date of last tetanus
Pre-existing conditions:
Does your child have any injuries or conditions that presently exist that would limit her from camp activities?
Y/N If yes, describe
Has your child had any sports or orthopedic (muscle, joint, etc) injury within the past year ?
Y/N If yes, describe
Has your child been diagnosed with any other significant chronic illness (diabetes, heart, epilepsy, etc?)
Y/N If yes, describe
I acknowledge that participation in Kingdom camps has an inherent risk. The child named above has my permission to participate in the designated Kingdom summer athletic camps. I understand that camp participation will involve significant physical activity which could result in injury. I certify that my child is in good physical condition and is fully able to participate. I assume all risk incidents to my child’s participation and release Kingdom, its employees, agents offices and volunteers from all liability, claim, expenses and actions which may arise from injury or harm to the child as a result of camp participation.

In the event of a medical emergency, I authorize Kingdom to designate a hospital, physician or emergency personnel to provide care (including hospitalization, if necessary) to the child and release Kingdom from any liability for injury or harm which to the child which may result from this medical care. I understand that responsibility for payment of such care medical care will be mine and certify that the child is covered by adequate medical care.
(Parent or Guardian)Signature

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Summer Camp Registration

Ages 14 & Under, $150 per Week, $600 all 4 weeks

Medical & Emergency Contact Form

Medical Information:

Pre-existing conditions:

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