2026 Breakaway VBS Sports Camp

2026 Breakaway VBS Sports Camp

CHEROKEE, NORTH CAROLINA: June 8 - 10, at Donald "Kool-Aid" Queen Gym (Wolftown Gym), 5pm - 8:30pm. A multi-sport VBS recreation camp for youth ages 6-14. (Please complete a separate form for each youth participant)
Cherokee’s third annual Breakaway VBS Sports Camp is bringing a special World Cup vibe to 2026! With the World Cup coming to the United States, we’re turning camp into a global celebration filled with high-energy sports, cultural spotlights from around the world, and faith-centered teaching that reminds kids God loves every nation. Each day includes skill-building sessions, team challenges, music and rallies, interactive cultural learning, and age-appropriate Bible stories. Designed for all skill levels, our rec-style camp creates a safe, encouraging space where no child is overlooked and everyone participates. We emphasize safety, positive coaching, character development, inclusion, and confidence building. Breakaway Outreach is a Christian-based nonprofit committed to helping kids build faith, develop life skills, and experience true belonging. Space is limited and registration is first come, first served.
Youth's Name*

First NameLast Name

Youth's Date of Birth*

MonthDayYear
Date
Youth's Age as of June 11, 2026*
Youth's Gender*
Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult XLAdult 2XL
Youth's Food/Medicine Allergies, Medical Alerts, etc.*
If none, type "N/A"
Name(s) of others attending the clinic who are related to this youth

Name of Youth's Parent/Guardian*

First NameLast Name
Relationship to Youth*
Email*
example@example.com
Primary Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Youth's Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact, Other Than Primary Guardian*

First NameLast Name
Emergency Contact's Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Name and phone number of additional driver(s) who have permission to pick up your child. If applicable, please include spouse/other parent who is not listed as the primary contact person above, or another youth parent who has your permission to pick up your child. It is not necessary to list your emergency contact again here:

As this minor camper's legal guardian, I certify that I am aware of the inherent risks associated with participating in sporting activities. I give my child permission to participate in all organized sports activities. On behalf of myself and my child, I hereby release, covenant not to sue, discharge, and hold harmless, Breakaway Outreach and Cherokee partners, its employees, agents, and representatives, of and from all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating to your participation in our programs, services or activities. I understand and agree that this release includes any claims based on the actions, omissions, or negligence of this organization, its employees, agents, and representatives, including any COVID-19 infection before, during, or after participation in any hosted or programmed event by this organization.*

I agree
I agree
In the unlikely event of an emergency, I authorize medical treatment or hospital care to be rendered to my child as needed in the judgment of the treating physician chosen by the Breakaway Outreach administrator or a representative of Cherokee Baptist Church. I shall be liable and agree to pay all costs and associated expenses incurred in connection with medical and dental services rendered to my child that are not covered by the limited policy of the host facility.*

I agree
I understand that photos and videos are part of the memory-making elements of the sporting activity, and that images of participants may appear in the event videos, host websites or social media albums, printed promotional materials, or organization/program reports. I agree that my child’s image may be used without expectancy of compensation. No personal information will be published without my permission.*

I agree
By entering my name here, this represents my signature and authorization as legal guardian of the above-referenced youth participant, and I give my consent to the terms therein. *

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Today's Date*

MonthDayYear
Date
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