Kingsport Full Life Sports Camp 2025 Camper Registration

Camper's Name*

First NameLast Name

Grade Completed *

Birthdate *

Date

Parent/Guardian's Name*

First NameLast Name

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Please enter a valid phone number.

Medical Concerns or Food Allergies*

Special Notes

Do you currently attend a local church?

If yes, what is the name of your local church?

Emergency Contacts (Name and Phone number)*

Dismissal Information (Who may pick up your child?)*

First Choice of Sport (please note that children remain in the same sport during the week, and once camp begins, they are unable to switch sports)*

Second Choice of Sport (if the first choice needs to be canceled due to low interest)*

I/we authorize that the Kingsport Community Church or its designees, to create, have and use photographs, slides, and videos containing my child"s image for its record keeping or marketing/public relations programs (must click yes or no):*

I have been informed of the above activity sponsored by Kingsport Community Church (KCC). Therefore, I now consent for my minor child to participate in this activity. I understand that the leaders of this activity will take all reasonable safety precautions and that the possibility of an unforeseen hazard does exist. Therefore, I further agree not to hold Kingsport City Schools, partner churches, or KCC employees and volunteer staff liable for damages, losses, diseases, or injuries by the minor listed on this form. I consent to any medical treatment that may be deemed necessary for my minor child. Further, I understand that all efforts will be made to contact me before treatment. If I cannot be reached in an emergency, I permit the activity leader to make the necessary decisions for treatment. Should there be no activity leader available, I authorize the attending physician to treat my minor child. Finally, I understand that the doctors, dentists, and other providers attending to my child will take all reasonable safety precautions during their care. Therefore, on behalf of myself and my heirs, administrators, and executors, I, at this moment, release and hold the Kingsport Community Church and its officers, partner churches, employees, volunteers, agents, and contractors harmless from all such claims for injury and damage. I understand that I would not be permitted to participate in any program Through KCC or use KCC or any partner facility or equipment without acceptance of this agreement. By selecting the check box, you agree to and accept the above terms and conditions.*

How will you be paying for Camp?*

Camper Registration: $25 ( If Card Selected please input information)

USDDescription

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