KAA Student/Parent Information Form
(This form is binding to your commitment and interest in your student's attendance to the Kids Across America Summer Camp)
Student's Name
First Name
Last Name
Age
DOB
School and Grade
Student's Email (If Applicable)
example@example.com
Kamper Shirt Size (unisex adult sizes)
Small
Medium
Large
XL
XXL
XXXL
Any known medical/physical health or mental health disabilities (including relevant physical impairments, learning disabilities, allergies, etc.; and medications associated) (Ex: ADHD, 30mg adderrall taken BID)
(KAA RESTRICTS ALL KAMPERS WHO ARE PHYSICALLY UNABLE TO PARTICIPATE IN HIGH IMPACT ACTIVITIES. If this is a concern, please reach out to KAA youth ministry team @ bwilliams@TheLuke.Org.)
Guardian's Full Name (1)
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Guardian's Full Name (2)
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address (if different from above)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
I am registering my student (OR SELF ) to attend the following KAA Kamp Experience (only based on the Age of the camper)
*
KAA 1 (10-12yo)
KAA 2 (13-14yo)
KAA 3 (15-18yo)
Adult Kaleo (KAA 1)
Adult Kaleo (KAA2)
Adult Kaleo (KAA3)
I would like to also register to attend as a KALEO (Adult Chaperone), as well
*
Yes
No
Parent/Guardian Signature
Continue
Continue
Should be Empty: