h2Kids Camp Registration
Camper Information
*
First Name
Last Name
Grade Entering Fall of 2024
*
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Please Select
Boy
Girl
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Shirt Size
*
Please Select
Youth-S
Youth-M
Youth-L
Adult-S
Adult-M
Adult-L
Parent/Guardian Information (Please Print)
*
First Name
Last Name
Primary Phone Number
*
Please enter a valid phone number.
Work Phone Number
*
Please enter a valid phone number.
Cell Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Parent/Guardian Information (Please Print)
First Name
Last Name
Primary Phone Number
Please enter a valid phone number.
Work Phone Number
Please enter a valid phone number.
Cell Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Relationship to Child
relationship to child
Additional Adults that can pick up you Child (Must be 18 years of age: photo ID May Be Required)
*
First Name
Last Name
Primary Phone Number
*
Please enter a valid phone number.
Work Phone Number
Please enter a valid phone number.
Cell Phone Number
Please enter a valid phone number.
Relationship to Child
*
relationship to child
Back
Next
General Consent (Check each box to indicate your understanding)
*
I Understand that my child will not be allowed at camp without forms being completed.
I herby Grant permission for my child to participate in activities of the Higher Hope Church Camp Program.
I herby grant my child permission for my child to be included in pictured for the higher hope website and/or Social Media
I understand that bringing personal toys, and electronics to camp is discouraged and any lost, stolen, or broken items are the owners responsibility.
,I understand that on feild Trip days my child must be at higher hope no later than 9 am
I herby grant permission for my child to be transported by bus to and from scheduled camp field trips
I hereby grant permission for Higher Hope Medical Staff to administer first aid or take whatever steps necessary to obtain emergency medical care if warranted. These steps may include: 1) Attempt to contact parent/guardian/authorized emergency contact and/or child’s physician. 2) Have the child taken to an emergency hospital in the company of a Higher Hope Staff Member. Any expenses will be the responsibility of the parent/guardian.
Health Information
Name of Physician
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Policy Holder Name
*
Insurance Carrier
*
Phone Number
*
Please enter a valid phone number.
Does your child have any known allergies? Please list
*
Does your child have Asthma?
*
Please Select
Yes
No
Will your child be bringing an inhaler or EPI Pen to camp?
*
Please Select
Yes
No
Are there any physical or psychological conditions requiring medication treatments or restrictions while at camp?
*
Please describe any specific activities from which your child should be exempt
*
Please list any dietary modifications or restrictions
*
Medication Consent
Over the counter Non-prescription (Tylenol, Tums, Neosporin, Allergy Medicine)
*
Please Select
Yes
No
My child has previously taken this medication
*
Please Select
Yes
No
Will the child need to be administered prescriptions during camp.
*
Please Select
Yes
No
Name of Child
*
Dosage
*
Date(s) medication is to be given
*
Time medication is to be given
*
Reason for medication
*
Possible Side Effects
*
Directions for storage
*
Parents Name
*
First Name
Last Name
I authorize medical staff at Higher Hope Church to administer medication to my child as indicated above.
*
Parent Signature
*
Submit
Submit
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