Cumberland Grove Kids Camp 2025

Kids Camp 2025 @ Cumberland Grove Family Camp

PLEASE NOTE: ALL CHILDREN MUST STAY WITH THEIR PARENTS. THERE ARE NO OVERNIGHT COUNSELORS OR ALL-DAY SUPERVISION. THERE ARE DESIGNATED TIME FOR CHILDRENS CHURCH AND ACTIVITIES. OUTSIDE OF THAT TIME, CHILDREN ARE REQUIRED TO BE WITH PARENTS/GUARDIANS.
All campers will be required to pay a $40 registration fee to the camp. Each camper will be required to pay $35to the kids camp. The total registration fee is $75. Register by June 25th to be guaranteed a t-shirt.
Name*

First NameLast Name
Birthdate *

MonthDayYear
Date
Age
Last Grade Completed *
Home Church
Gender*

MaleFemale
Parent/ Guardian Information*

First NameLast Name
Emergency Contact *

First NameLast Name
Relationship*
Phone Number*
Please enter a valid phone number.
TShirt Size

Youth SmallYouth MediumYouth LargeYouth XLAdult SmallAdult MediumAdult LargeAdult XL
Does the camper have any allergies, chronic illness, or medical conditions? If yes, please describe. In no, please type n/a.*
Does the camper require a specific diet: example Gluten Free, Diabetic. *
Requirement: Only those who are over 5yrs and have completed PK or K may participate without an adult accompanying them ; Under 5 is still welcome to participate but MUST have an adult with them at all times during the activities.
I understand that only those campers who are over 5yrs and have completed PK or K may participate in activities without an adult accompanying them; Under 5 may still participate but MUST have an adult with them at all times.*

Yes
I understand that after afternoon activities, either I or a named responsible adult party is required to supervise my child and that no camper 10 or under may stay in the dorms but must stay with responsible adult party.*

Yes
Responsible party of named camper while on grounds.*

First NameLast Name
*Important*

The following is provided for campers 10 and under: Morning service at 10:30am- You may drop your child off at 10:15. Afternoon activities begin at 1:00. We will meet at the snack stand. At 2:30 all campers will be returned to their guardian. Campers need to be checked out in the children's room.
*Medical Release and Authorization*

As a parent or guardian of the named camper, I hereby authorize the diagnosis and treatment by qualified and licensed medical professionals, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professionals, requires immediate attention to prevent further endangerment of the minor's life, physical impairment, or other undue pain, suffering, or discomfort if delayed. Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named camper. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me quickly. This authorization is granted only after a reasonable effort has been made to reach me. Permission is also granted to the Cumberland Grove Wesleyan Camp and its affiliates including directors, workers, and counselors, to provide the needed emergency treatment prior to the child's admission to the medical facility. Release is authorized on the dates and/or duration of the registered camp. This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of the named minor child, in my absence.
Signature*

Clear
Informed consent and acknowledgement

I hereby give my approval for my child to participate in any and all activities during the camp. I assume all risk and hazards incidental to the conduct of activities, and release, absolve and hold harmless Cumberland Grove Wesleyan Camp and all respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, and returning from selected camp sessions. In case of injury to the camper, I hereby waive all claims against Cumberland Grove Wesleyan Camp.
Signature

Clear
Confirmation

By acknowledging and signing below, I am delivering an electronic signature that will have the same affect as an original manual paper signature. The electronic signature will be equally as binding as an original manual paper signature.
Signature

Clear
Should be Empty:

Kids Camp 2025 @ Cumberland Grove Family Camp

All campers will be required to pay a $40 registration fee to the camp. Each camper will be required to pay $35to the kids camp. The total registration fee is $75. Register by June 25th to be guaranteed a t-shirt.

*Important*

*Medical Release and Authorization*

Informed consent and acknowledgement

Confirmation

Important

Medical Release and Authorization