Campassion February Break Camp Registration Form
Registration Window Opens November 20th Closes December 20th, 2023. Please note that there is a capacity limit, however families will be notified by January 1st about official enrollment. I appreciate your understanding!
Camper's Information
Child's Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Parent Email
example@example.com
Parent Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
School Name
School/Grade Level
Teacher/Teacher Email
Parent/Guardian Information
The parents/guardian listed below will be the authorized person to pick-up the child after the camp.
The parents/guardian listed below will also be the primary emergency contact person.
Name
First Name
Last Name
Relation
Phone Number
-
Area Code
Phone Number
Name
First Name
Last Name
Relation
Phone Number
-
Area Code
Phone Number
Student Profile
What would you like me to know about your child before camp begins?
What are some of their interests?
Why might your child be interested in learning more about service, gratitude, mindfulness, and exercise? Please provide any examples, whether it's through previous experience or even through conversations!
Medical Information
Does your child have any allergies? If yes, please list them below:
Does your child have any previous injuries? If yes, please explain them below:
Does your child have any current medical conditions? If yes, please list them below:
Does your child takes any medication? If yes, please list them below and provide any additional information you might like me to know:
Authorization
I, the parent/guardian of this camper gives authority to the staff of this camp to apply judgment in regards to medical assistance in the event of an accident, injury, or illness if the emergency contact person cannot be reached. I authorized first aid, medical/surgical diagnosis, and treatment which may deem necessary.
I released the organizers, coaches, staff, or managers of this camp for any responsibility in case of accident, illness, or injury during my child's enrollment.
I confirm that all information given in this form is true, complete, and accurate.
Media Release: I agree that I give my child permission to appear in videos, audio recordings, films, photographs, written articles, and on websites and social media sites.
Parent/Guardian Signature
Submit
Submit
Print Form
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